SELECTED ARTICLES FROM THE RECENT LITERATURE 2003
12/29/03
Systematic review of evidence for potential complications of inhaled
corticosteroid use in asthma
Summary
Most available clinical guidelines have strongly recommended the use of
inhaled corticosteroids (ICS) to achieve long-term control of chronic
asthma. However, there have been persistent concerns about possible adverse
effects of long-term ICS therapy. An expert panel representing the American
College of Chest Physicians, the AAAAI and the ACAAI has reviewed the
available evidence with respect to the possible risk of ICS adverse effects.
The Medline and EMBASE databases were searched using a list of NLM search
terms/key words. The available information was reviewed and the reviewers
listed their conclusions based on study results, with a quality rating score
assigned. After extensive review of the summary data, the expert panel
arrived at a final conclusion that the proven clinical effectiveness of ICS
treatment of asthma decidedly outweighs the proven risks of ICS
administration.
Reference
Chest 2003;124:2329-40
Editor's Comments
The overall conclusions of the highly respected asthma investigators and
clinicians in this expert panel are quite reasonable. However, I think that an
important point about ICS therapy bears emphasis. There is convincing evidence
that the beneficial effects of ICS in most adult asthma patients is
dose-dependent up to a daily dose of 800-1000 mcg/day for most preparations.
There is much less added benefit with increasing doses of ICS above that level.
At the same time, the potential for systemic adverse effects of ICS keep
increasing progressively at daily doses of most ICS agents above 1000 mcg/day
than at does below 800 mcg/day.
Of course, there are patients with severe asthma in whom it is felt that even a
modest additional benefit makes it worth increasing the adult dose over 1000
mcg/day. An alternative would be to use a combination of an ICS at lower dose
along with an inhaled long acting beta agonist (LABA). Several studies have
shown that concomitant use of an ICS and LABA allows asthma control with about
50% of the ICS dose if the latter was used as monotherapy.
|