Association of Inhaled Corticosteroid Use With Cataract Extraction in Elderly Patients

Garbe, Edeltraut

doi:10.1001/jama.280.6.539

Cited by 181 publications

(84 citation statements)

References 43 publications

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“…Growth velocity does transiently decrease with initiation of inhaled corticosteroid treatment in prepubertal children, but this effect does not seem to result in diminution of actual height attained. 17,18 The risk of developing either cataracts 19,20 or osteoporosis 21 is small. Skin bruising does occur with long-term use of inhaled corticosteroids, especially in the elderly, but this is primarily a cosmetic problem.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 Although these observations are reassuring, it must be acknowledged that long-term use of high doses of inhaled corticosteroids have been associated with such side effects as Cushing's syndrome, growth retardation, osteopenia, myopathy and cataracts. 19,20,24 The benefit versus risk profile of inhaled corticosteroids is clearly favorable at low-to-medium doses. Considerable benefit can be achieved with little risk of adverse systemic effects.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Categorizing Asthma Severity: An Overview of National Guidelines

Colice¹

2004

Clinical Medicine & Research

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Categorizing Asthma Severity: An Overview of National Guidelines

Colice¹

2004

Clinical Medicine & Research

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“…The use of corticosteroids by nasal spray and inhalation has been associated with the development of posterior subcapsular cataracts as reported by Fraunfelder and Meyer [4]. Garbe et al [5] similarly concluded that prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients. They found out that the odds ratio for cataract extraction in patients with prolonged cumulative exposure to inhaled corticosteroids compared with non-users was 3.40.…”

Section: Discussionmentioning

confidence: 95%

Ocular manifestations of occupational exposure to corticosteroids in the pharmaceutical industry

Metwally¹,

El-Assal²,

Kamel³

2006

WIT Transactions on Biomedicine and Health, Vol 10

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The therapeutic use of corticosteroids has long been associated with ocular side effects such as the development of cataracts, glaucoma, and retinal and choroidal emboli. This study was conducted to assess ocular disorders, which may occur in workers engaged in manufacturing corticosteroids in the pharmaceutical industry. The study population included 58 workers involved in the manufacturing of corticosteroid preparations. They were subdivided according to duration of exposure into 2 groups: Gr. I of <15 years duration of employment and Gr. II of 15 + years duration of employment. Methods included answering a structured questionnaire enquiring about occupational and medical histories, full ocular and clinical examination, and measurement of certain biochemical parameters, such as plasma cortisol, serum total cholesterol, serum triglycerides, fasting blood sugar and serum calcium. Results showed that 25 cataracts were diagnosed in the studied group with a rate of 21.55 per one hundred eyes. Of Gr.II, 43.75% of eyes had cataracts compared to 5.88% of Gr.I. Odds ratio to develop cataracts was 12.44 for Gr. II compared to Gr.I. Ocular hypertension and open-angle glaucoma were present in 25.00% of the eyes of the studied groups with odds of 5.83 times more when being employed for 15 or more years. Significant +ve correlation was found between intraocular pressure and relevant biochemical parameters. In the present study, a clear relationship was detected between the length of the period of exposure to corticosteroids as environmental pollutants and the development of ocular medical disorders such as cataracts, ocular hypertension and glaucoma. Further research work is needed to study the effects of exposure to corticosteroids as pollutants in the work environment, gaining access into body via unusual routes of entry, and for periods of time not reported in the therapeutic literature.

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“…The sample size of this study was likely insufficient to evaluate the influence of daily ICS dosage and duration of treatment. In elderly patients with chronic obstructive respiratory diseases, Garbe et al [35] investigated the association between the risk of cataract extraction and the use of ICS. The authors found that, independently of the dose employed, prolonged (more than 3 years) treatment with ICS was associated with elevated risk of cataract extractions.…”

Section: Cataractmentioning

confidence: 99%

“…The authors found that, independently of the dose employed, prolonged (more than 3 years) treatment with ICS was associated with elevated risk of cataract extractions. Of note, cataract extraction was more frequent in patients using a high ([1 mg) average daily dose of beclomethasone dipropionate or budesonide for more than 2 years [35]. More recently, a meta-analysis [36] on two databases from UK and Canada on the use of ICS in adult and elderly patients concluded that the risk of cataracts increased by about 25 % for each 1,000 lg increase in daily dose of beclomethasone dipropionate or equivalent.…”

Section: Cataractmentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

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Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

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Association of Inhaled Corticosteroid Use With Cataract Extraction in Elderly Patients

Cited by 181 publications

References 43 publications

Categorizing Asthma Severity: An Overview of National Guidelines

Categorizing Asthma Severity: An Overview of National Guidelines

Ocular manifestations of occupational exposure to corticosteroids in the pharmaceutical industry

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

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