Side effects of inhaled corticosteroids

Inhaled corticosteroid (ICS) therapy carries less risk of complicating drug- or disease-related morbidity and mortality than that associated with other antiasthmatic drugs such as prednisone, theophylline, or β 2 -agonist bronchodilators. Serious side effects are uncommon, but the risk increases with the daily dose. The degree of risk is most effectively minimized by ensuring each patient uses the smallest daily dose sufficient to maintain optimum control of their disease. Any patient in whom ocular symptoms develop while receiving ICS therapy should promptly be evaluated by an eye specialist. Growth velocity is commonly reduced during ICS therapy and should be monitored routinely. Bone metabolism may be affected by low or medium doses of ICS, but there is no evidence such doses cause osteoporosis or fracture. High-dose therapy may reduce bone density and increase the risk of fracture, particularly if other risk factors for osteoporosis are present. Research is needed to better define the impact of ICS therapy in children on height and peak bone density attained at maturity. Also, there is a need for practice guidelines specifically applicable to the prevention of bone loss during ICS treatment. (J Allergy Clin Immunol 1998;102:705-13.)