SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
11/15/04
Skin manifestations of inhaled corticosteroids treatment in COPD
Summary
Background - There are current extensive controlled trials of treatment with moderate to high dosage inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD). Questions have been raised whether there are adverse systemic effects of such ICS therapy.
Findings - Tashkin et al of the UCLA School of Medicine in Los Angeles, CA compared the incidence of adverse systemic effects in 1,116 patients with COPD undergoing a randomized, double-blind trial comparing inhaled triamcinolone (Tri) 1200 mcg/day vs placebo for 3.5 - 4.5 years. They found a significantly higher incidence of skin bruising in those receiving inhaled Tri than inhaled placebo (11.2 vs 3.5%). The slow healing of skin cuts or sores was also reported more commonly by those treated with Tri (2.5 vs 0.5%). There was no correlation between occurrence of these skin effects and any alterations in the HPA axis or bone density in these patients.
Reference
Chest 2004;126:1123-33
Editor's Comments
The increase in skin bruising and slow healing in those receiving Tri treatment looks impressive. However, when trying to extrapolate these findings to asthmatics treated with ICS, one should remember: 1) these COPD patients are older than most asthmatic patients (ages 40-69 years); 2) COPD patients often have poor protein nutrition which may lead to susceptibility to skin bruising and decreased skin healing; 3) the patients were treated with higher doses of Tri than is recommended for chronic ICS use in asthmatics (< 800 mcg/day in adults). One would have also wanted to see findings of a similar study using ICS agents that should have less systemic effects than Tri, such as fluticasone or budesonide used in doses of < 800 mcg/day.
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