Benefit Versus Risk for Oral, Inhaled, and Nasal Glucocorticosteroids
Section snippets
Factors that determine the benefit/risk ratio in an individual
Factors that determine the balance of benefits and risks of glucocorticosteroid treatment in an individual include those relating to the drug and the individual. Factors relating to the drug include: (1) whether the drug is delivered orally or topically, (2) the extent of systemic absorption in relation to route of administration and the consequent biologic and clinical adverse effects, (3) dose, duration, and dosing schedule, and (4) differences in pharmacokinetic and pharmacodynamic
Benefit-to-risk analysis: public health perspective
Allergic rhinitis and asthma are among the most common chronic diseases affecting people in more-developed countries. These diseases are important causes of morbidity and have an impact on society in terms of lost productivity and increased use of health care resources. Glucocorticosteroids are effective treatments for these conditions, controlling symptoms and preventing exacerbations and deaths from asthma. The reduction in the need for oral glucocorticosteroids with the increased use of
Summary
Many factors affect the benefit-to-risk analysis of the use of glucocorticosteroids in the treatment of allergic inflammation. For most patients the benefit-to-risk ratio favors topical over oral administration, but in severe disease oral administration may be required. It is clear from pharmacokinetic and pharmacodynamic studies that inhaled glucocorticosteroids in particular are absorbed into the systemic circulation and that they can have clinical adverse effects when given in high doses.
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Managing patients with chronic severe asthma: Rise to the challenge
2009, European Journal of Internal MedicineCitation Excerpt :Unfortunately, this subgroup of patients usually needs high doses of prednisone (> 30 mg/day) in order to attain an adequate asthma control, and exhibit a deterioration as soon as the dose of corticosteroids is tapered. Hence, reasonable control of their asthma can only be achieved at the cost of significant adverse effects such as osteoporosis, diabetes, hypertension, cataract formation, GI bleeding, myopathy, adrenal insufficiency, susceptibility to infections, weight gain and skin thinning [67,68]. In consideration of this, careful monitoring of bone mineral density (if adequate bone therapy is prescribed, DEXA scan should be carried out every 3 years [69,70], fasting glucose and blood pressure should be arranged.
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2006, LancetCitation Excerpt :These treatments can also be added to the combination therapy. Because corticosteroids by inhalation begin to lose their efficacy as the dose increases above 800–1000 μg beclometasone dipropionate-equivalents per day and because both local and systemic side-effects (osteoporosis, skin thinning, and cataracts) increase, care should be taken with doses in excess of 2000 μg/day, especially in patients beyond middle age.125 A new corticosteroid, ciclesonide, seems to have a greater therapeutic index but has not yet been approved for high-dose use in severe asthma.126
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KM does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. Since 2002 Astra Zeneca has paid £2000 into the department for consultancy work by Dr. Tattersfield.