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Titolo:
Systemic adverse effects of inhaled corticosteroid therapy - A systematic review and meta-analysis
Autore:
Lipworth, BJ;
Indirizzi:
Univdeendee, Ninewells Hosp & Med Sch, Dept Clin Pharmacol & Therapeut, Dun Univ Dundee Dundee Scotland DD1 9SY Dept Clin Pharmacol & Therapeut, Dun Univandndee, Ninewells Hosp & Med Sch, Dept Resp Med, Dundee DD1 9SY, Scotl Univ Dundee Dundee Scotland DD1 9SY Dept Resp Med, Dundee DD1 9SY, Scotl
Titolo Testata:
ARCHIVES OF INTERNAL MEDICINE
fascicolo: 9, volume: 159, anno: 1999,
pagine: 941 - 955
SICI:
0003-9926(19990510)159:9<941:SAEOIC>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
BONE-MINERAL DENSITY; URINE CORTISOL EXCRETION; LONG-TERM TREATMENT; POSTERIOR SUBCAPSULAR CATARACTS; LARGE-VOLUME SPACER; ADULT ASTHMATIC-PATIENTS; FLUTICASONE PROPIONATE; BECLOMETHASONE DIPROPIONATE; ADRENAL-FUNCTION; DOSE-RESPONSE;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
149
Recensione:
Indirizzi per estratti:
Indirizzo: Lipworth, BJ Univdeendee, Ninewells Hosp & Med Sch, Dept Clin Pharmacol & Therapeut, Dun Univ Dundee Dundee Scotland DD1 9SY rmacol & Therapeut, Dun
Citazione:
B.J. Lipworth, "Systemic adverse effects of inhaled corticosteroid therapy - A systematic review and meta-analysis", ARCH IN MED, 159(9), 1999, pp. 941-955

Abstract

Objective: To appraise the data on systemic adverse effects of inhaled corticosteroids. Methods: A computerized database search from January 1, 1966, through July31, 1998, using MEDLINE, EMBASE, and BIDS and using appropriate indexed terms. Reports dealing with the systemic effects of inhaled corticosteroids on adrenal gland, growth, bone, skin, and eye, and reports on pharmacology and pharmacokinetics were reviewed where appropriate. Studies were included that contained evaluable data on systemic effects in healthy volunteers as well as in asthmatic children and adults. A statistical meta-analysis usingregression was performed for parameters of adrenal suppression in 27 studies. Results: Marked adrenal suppression occurs with high doses of inhaled corticosteroid above 1.5 mg/d (0.75 mg/d for fluticasone propionate), although there is a considerable degree of interindividual susceptibility. Metaanalysis showed significantly greater potency for dose-related adrenal suppression with fluticasone compared with beclomethasone dipropionate, budesonide, or triamcinolone acetonide, whereas prednisolone and fluticasone propionatewere approximately equivalent on a 10:1-mg basis. Inhaled corticosteroids in doses above 1.5 mg/d (0.75 mg/d for fluticasone propionate) may be associated with a significant reduction in bone density, although the risk for osteoporosis may be obviated by postmenopausal estrogen replacement therapy. Although medium-term growth studies showed suppressive effects with 400-mug/d beclomethasone dipropionate, there was no evidence to support any significant effects on final adult height. Long-term, high-dose inhaled corticosteroid exposure increases the risk for posterior subcapsular cataracts, and, to a much lesser degree, the risk for ocular hypertension and glaucoma. Skin bruising is most likely to occur with high-dose exposure, which correlates with the degree of adrenal suppression. Conclusions: All inhaled corticosteroids exhibit dose-related systemic adverse effects, although these are less than with a comparable dose of oral corticosteroids. Metaanalysis shows that fluticasone propionate exhibits greater dose-related systemic bioactivity compared with other available inhaled corticosteroids, particularly at doses above 0.8 mg/d. The long-term systemic burden will be minimized by always trying to achieve the lowest possible maintenance dose that is associated with optimal asthmatic control and quality of life.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/09/20 alle ore 18:46:29