Incidence of serious complications of corticosteroid therapy in respiratory disease: A retrospective survey of patients in the Brompton Hospital

Abstract

A retrospectively controlled study is described of mortality and serious morbidity in 550 patients treated with corticosteroids and 499 controls. The overall incidence of side-effects was similar in both groups, but gastro-intestinal bleeding, diabetes, and mental disturbance early in treatment occurred more frequently in the corticosteroid group. Other individual side-effects did not occur significantly more often than in the controls, but there was an overall increased frequency of complications with increased dose, and also an increased mortality with increase in the maintenance dose. Gastro-intestinal bleeding was not related to a past or present chronic peptic ulcer, and was not commoner in treated patients. Reactivation of tuberculosis and exacerbation of mental disturbance did not occur. Weight gain occurred in 29% of patients, but appeared to be related closely to a satisfactory response to treatment. Hypertension occurred in 4% of the treated group. Overall mortality in the two groups was similar. Mortality due specifically to corticosteroids was difficult to assess: two patients died of haematemesis and three died with severe asthma during withdrawal of treatment, but there was no increase in mortality following physical stress in the treated series. Sudden death in asthmatics was not more frequent in corticosteroid-treated patients. All seven control patients who died suddenly with asthma were middleaged. Increase in duration of treatment was not associated with increased risk. Indeed the longterm, low-dose group had a lower incidence of complications than the rest and a mortality similar to that of the controls. A trial of corticosteroids for less than one month carried no risk in 41 patients.

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

“…Smyllie HC et al and Slatore CG et al concluded that glucose control is more difficult with steroid based therapy in COPD. 25,27 Impaired glucose tolerance and diabetes mellitus is less common in patients taking inhaled corticosteroid therapy which is comparable to previous studies conducted by Spencer S et al and Calverley PM et al 14,15 …”

“…[17][18][19][20][21][22][23][24] Glucose control is more difficult with steroid based therapy in COPD. [25][26][27] One study shows 15% of COPD patient requires additional treatment for hyperglycemia as compared to 4% of control group. [28][29][30] In addition to this some case reports describe loss of glucose control in patient receiving ICS based therapy.…”

Asthma Severity, Psychiatric Morbidity, and Quality of Life: Correlation with Inhaled Corticosteroid Dose

“…Their effects on the hypothalamic-pituitary-adrenal (HPA) axis, immunity, glucose metabolism, growth in children, cataract development, and bone mineral density are wellestablished (16)(17)(18)(19)(20)(21)(22)(23)(24). Several studies have also reported oral/parenteral-induced adverse psychiatric effects (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). These include mood disturbances, psychosis, confusion, and memory problems.…”

Benefits of Screening for Latent Mycobacterium tuberculosis Infection

“…23 Persons with silicosis, leukemia or lymphoma, end-stage renal disease treated with dialysis, or prolonged corticosteroid therapy may benefit greatly from preventive therapy if the relative risk of developing disease during their lifetimes is high, as shown in some studies [51][52][53][54][55][56][57]69,70,77,79 but not in others. 58,71,72,75,76,78 This analysis also leads to 4 additional significant conclusions about screening and preventive therapy. First, the benefits of screening are reduced if persons with positive tests do not initiate preventive therapy.…”