Imperial College London
Portrait Picture

DrChloeBloom

Faculty of Medicine, National Heart & Lung Institute

Clinical Senior Lecturer in Respiratory Epidemiology
 
 
 
//

Contact

 

chloe.bloom06

 
 
//

Location

 

Emmanuel Kaye BuildingRoyal Brompton Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Patel:2020:10.1136/bmjresp-2020-000756,
author = {Patel, R and Naqvi, S and Griffiths, C and Bloom, C},
doi = {10.1136/bmjresp-2020-000756},
journal = {BMJ Open Respiratory Research},
title = {Systemic adverse effects from inhaled corticosteroid use in asthma: a systematic review},
url = {http://dx.doi.org/10.1136/bmjresp-2020-000756},
volume = {7},
year = {2020}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background Oral corticosteroid use increases the risk of systemic adverse effects including osteoporosis, bone fractures, diabetes, ocular disorders and respiratory infections. We sought to understand if inhaled corticosteroid (ICS) use in asthma is also associated with increased risk of systemic effects.Methods MEDLINE and Embase databases were searched to identify studies that were designed to investigate ICS-related systemic adverse effects in people with asthma. Studies were grouped by outcome: bone mineral density (BMD), respiratory infection (pneumonia or mycobacterial infection), diabetes and ocular disorder (glaucoma or cataracts). Study information was extracted using the PICO checklist. Risk of bias was assessed using the Cochrane Risk of Bias tool (randomised controlled trials) and Risk of Bias In Non-randomised Studies of Interventions-I tool (observational studies). A narrative synthesis was carried out due to the low number of studies reporting each outcome.Results Thirteen studies met the inclusion criteria, 2 trials and 11 observational studies. Study numbers by outcome were: six BMD, six respiratory infections (four pneumonia, one tuberculosis (TB), one non-TB mycobacteria), one ocular disorder (cataracts) and no diabetes. BMD studies found conflicting results (three found loss of BMD and three found no loss), but were limited by study size, short follow-up and lack of generalisability. Studies addressing infection risk generally found positive associations but suffered from a lack of power, misclassification and selection bias. The one study which assessed ocular disorders found an increased risk of cataracts. Most studies were not able to fully adjust for known confounders, including oral corticosteroids.Conclusion There is a paucity of studies assessing systemic adverse effects associated with ICS use in asthma. Those studies that have been carried out present conflicting findings and are limited by multiple biases and residual confounding. Furth
AU  - Patel,R
AU  - Naqvi,S
AU  - Griffiths,C
AU  - Bloom,C
DO  - 10.1136/bmjresp-2020-000756
PY  - 2020///
SN  - 2052-4439
TI  - Systemic adverse effects from inhaled corticosteroid use in asthma: a systematic review
T2  - BMJ Open Respiratory Research
UR  - http://dx.doi.org/10.1136/bmjresp-2020-000756
UR  - http://hdl.handle.net/10044/1/84875
VL  - 7
ER  -
Download