Inhaled corticosteroids (ICS) are first-line therapy for asthma and are also commonly used in the treatment of chronic obstructive pulmonary disease (COPD), in particular for those patients with moderate–severe disease and frequent exacerbations. They are preferred to oral corticosteroids because of a lower risk of systemic adverse effects, although high doses of ICS have been reported to be associated with adrenal suppression, glaucoma, osteoporosis, cataracts, pneumonia, bruising and decreased growth in children.
Oral corticosteroids increase the risk of diabetes mellitus and worsen glucose control in patients already diagnosed with the disease. Case reports have linked high doses of ICS with loss of glucose control, but a randomised controlled trial in patients with mild-moderate COPD (n= 1116) did not find an increased risk of diabetes associated with ICS use. The small number of subjects in this trial is a major limitation.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.