inhaled glucocorticoid
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Indications
- prophylaxis
- reduction in need for 'rescue' beta-adrenergic agonists
- acute exacerbations of asthma
Dosage
- prophylaxis (see specific agent)
- 100-500 ug beclomethasone equivalents
- intermittent therapy may be appropriate for some patients with mild asthma[7]
- acute exacerbations of asthma
- high dose (4X prophylactic dose) in combination with beta-adrenergic receptor agonists[3]
- reduce to prophylactic dose after acute exacerbation resolves[4]
- no benefit in doubling dose[5] for patients on inhaled glucocorticoid alone (no beta-adrenergic agonist)
Pharmacokinetics
- some is systemically absorbed
Adverse effects
- cataracts
- glaucoma
- easy bruising
- osteoporosis
- long-term use of moderate-dose (< 400 ug/day) NOT associated with increased risk of fractures in the elderly[2][9]
- high-dose in the elderly may be associated with increased risk of fracture[6][9] (> 700 ug beclomethasone equivalents/day)[6] (> 600 ug /day)[9]
- 3 years of inhaled glucocorticoids does not affect bone mineral density[10]
- long-term is associated with a modest increased risk of fracture in patients with COPD[13][18]
- no increased risk of fractures in children with asthma[17]
- weight gain with high doses
- diabetes mellitus & diabetes progression (dose-dependent)[11] (RR=1.6 at highest doses)
- increased risk of hyperglycemia when used in high doses, i.e. fluticasone 1000 ug/day
- maintenance inhaled glucocorticoids stunt growth in asthmatic children
- 1.2 cm mean adult height difference[15]
- adrenal suppression[19]
- higher body mass index (BMI) in children[19]
- risk of pneumonia may be dependent on comorbidities
Drug interactions
- in patients taking ritonavir, abrupt withdrawal of glucocorticoids metabolized by cyt-P450 3A4 including inhaled glucocorticoids fluticasone & budesonide can result in adrenal insufficiency
- no abdominal hyperpigmentation[20]
- drug interaction(s) of methotrexate with biological response modifier
- drug interaction(s) of glucocorticoids with warfarin
- drug interaction(s) of NSAIDs with glucocorticoid
More general terms
More specific terms
Additional terms
Component of
References
- ↑ Journal Watch 20(11):88, 2000 Wong CA et al Inhaled corticosteroid use and bone-mineral density in patients with asthma. Lancet 355:1399, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10791523 Sambrook PN Inhaled corticosteroids, bone density, and risk of fracture. Lancet 355:1385, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10791519
- ↑ 2.0 2.1 Journal Watch 24(4):34, 2004 Suissa S et al Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care Med 169:83, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14551165
- ↑ 3.0 3.1 Prescriber's Letter 8(5):29 2001
- ↑ 4.0 4.1 Journal Watch 23(14):114, 2003 Hawkins G et al Stepping down inhaled corticosteroids in asthma: randomised controlled trial. BMJ 326:1115, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/12763981 <Internet> http://bmj.com/cgi/content/full/326/7399/1115
- ↑ 5.0 5.1 Prescriber's Letter 11(3):15 2004 Journal Watch 24(5):40, 2004 Harrison TW et al, Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial. Lancet 363:271, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14751699
- ↑ 6.0 6.1 6.2 Journal Watch 24(10):81-82, 2004 Kemp JP, Osur S, Shrewsbury SB, Herje NE, Duke SP, Harding SM, Faulkner K, Crim CC. Potential effects of fluticasone propionate on bone mineral density in patients with asthma: a 2-year randomized, double- blind, placebo-controlled trial. Mayo Clin Proc. 2004 Apr;79(4):458-66. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15065610
Lee TA, Weiss KB. Fracture risk associated with inhaled corticosteroid use in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004 Apr 1;169(7):855-9. Epub 2004 Jan 07. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14711795 - ↑ 7.0 7.1 Prescriber's Letter 12(6): 2005 As-Needed Inhaled Corticosteroids for Mild Persistent Asthma Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210608&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jani M, Ogston S, Mukhopadhyay S. Annual increase in body mass index in children with asthma on higher doses of inhaled steroids. J Pediatr. 2005 Oct;147(4):549-51. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16227047
- ↑ 9.0 9.1 9.2 9.3 Hubbard R et al. Use of inhaled corticosteroids and the risk of fracture. Chest 2006 130:1082-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17035441
- ↑ 10.0 10.1 Ferguson GT et al. Prevalence and progression of osteoporosis in patients with COPD: Results from the Towards a Revolution in COPD Health Study. Chest 2009 Dec; 136:1456. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19581353
- ↑ 11.0 11.1 Suissa S et al. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med 2010 Nov; 123:1001. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20870201
- ↑ 12.0 12.1 O'Byrne PM et al. Risks of pneumonia in patients with asthma taking inhaled corticosteroids. Am J Respir Crit Care Med 2011 Mar 1; 183:589 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20889908
- ↑ 13.0 13.1 Loke YK et al. Risk of fractures with inhaled corticosteroids in COPD: Systematic review and meta-analysis of randomised controlled trials and observational studies. Thorax 2011 Aug; 66:699 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21602540
- ↑ Prescriber's Letter 18(10): 2011 Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271022&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 15.0 15.1 Kelly HW et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med 2012 Sep 3 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22938716 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1203229
- ↑ 16.0 16.1 Suissa S et al. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest 2015 Nov; 148:1177 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26110239 <Internet> http://journal.publications.chestnet.org/article.aspx?articleid=2363032
- ↑ 17.0 17.1 Gray N, Howard A, Zhu J et al Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma. JAMA Pediatr. Published online November 13, 2017 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29131874 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2661821
- ↑ 18.0 18.1 Gonzalez AV, Coulombe J, Ernst P, Suissa S et al. Long-term use of inhaled corticosteroids in COPD and the risk of fracture. Chest 2018 Feb; 153:321. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28716642 <Internet> http://journal.chestnet.org/article/S0012-3692(17)31243-6/fulltext
Cho YJ, Sin DD. Inhaled corticosteroids and fractures in COPD: Can we finally put this to bed? Chest 2018 Feb; 153:293. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29406210 <Internet> http://journal.chestnet.org/article/S0012-3692(17)31481-2/fulltext - ↑ 19.0 19.1 19.2 Kunoe A, Sevelsted A, Chawes BL et al. Associations between inhaled corticosteroid use in the first 6 years of life and obesity-related traits. Am J Respir Crit Care Med 2021 Sep 15; 204:642. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33975528 https://www.atsjournals.org/doi/10.1164/rccm.202009-3537OC
- ↑ 20.0 20.1 NEJM Knowledge+ Complex Medical Care