Local side‐effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device

Dubus, Jean‐Christophe; Marguet, Christophe; Deschildre, A.; Mély, Laurent; Roux, P. Le; Brouard, Jean J.; Huiart, Laëtitia; Pédiatrique, Réseau de Recherche Clinique en Pneumonologie

doi:10.1034/j.1398-9995.2001.00100.x

Cited by 152 publications

(134 citation statements)

References 27 publications

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“…Os efeitos locais incluem tosse durante a inalação, secura na garganta, rouquidão, disfonia e candidíase oral 54,55 . A higienização oral após o uso do CEI auxilia na redução desses efeitos dose-dependentes.…”

Section: Efeitos Adversos Locaisunclassified

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Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo

Solé

2006

J Pediatr (Rio J)

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Objective: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma.Sources: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected.Summary of the findings: In vivo and in vitro studies show that t h e a v a i l a b l e I C S h a v e d i f f e r e n t p h a r m a c o k i n e t i c a n d pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate.Conclusions: ICS are the main anti-inflammatory agent used to treat persistent asthma. When administered in low doses, they seem to be safe and effective. Patient monitoring allows for early detection of possible side effects associated with ICS.J Pediatr (Rio J). 2006;82(5 Suppl):S198-205: Children, asthma, inhaled corticosteroids, budesonide, beclomethasone, fluticasone, ciclesonide. ResumoObjetivo: Revisar os mecanismos moleculares de ação, eficácia e potenciais efeitos adversos relacionados aos corticosteróides inalados (CEI) em crianças com asma persistente.Fontes dos dados: Artigos de língua inglesa da base de dados MEDLINE. Foram empregados os termos: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, oral candidiasis. Foram selecionados guias de tratamento, artigos de revisão, estudos controlados, meta-análises e revisões sistemáticas que avaliaram a eficácia e os eventos adversos do tratamento com CEI. Síntese dos dados:Estudos in vivo e in vitro mostram que os CEI disponíveis apresentam diferentes características farmacociné-ticas e farmacodinâmicas que lhes conferem diferentes potenciais de ação. Os CEI também diferem quanto aos efeitos adversos sistêmicos e locais. Salienta-se a biodisponibilidade desses produtos como essencial para determinar a incidência de efeitos colaterais. Em linhas gerais, os CEI são capazes de controlar a asma, reduzindo o número de exacerbações, atendimentos médicos, hospitalizações e a necessidade de pulsos de corticosteróides orais. Também se observa melhora da função pulmonar, sobretudo nos pacientes com asma ...

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Section: Efeitos Adversos Locaisunclassified

“…Por não ser ativada na mucosa oral, a CIC proporciona uma chance significativamente menor de efeitos adversos locais. O uso de dispositivos pode promover menor deposição na orofaringe 54,55 .…”

Section: Efeitos Adversos Locaisunclassified

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo

Solé

2006

J Pediatr (Rio J)

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“…We believe a dual effect underlies these findings: (1) the improved strength may be related to some degree of transient muscle fiber hypertrophy. Tongue hypertrophy has been reported in children treated with ICS, 43,44 as soon as 4-7 weeks into treatment. 44 This effect is believed to be partly due to muscle fiber hypertrophy 43,44 ; (2) the reduced endurance could reflect incipient functional deficits, building-up as a result of differential effects on the tissue compartments comprising the tongue, such as (a) unmasked preexistent inflammation-induced remodeling/dysfunction, and/or (b) a direct drug effect on the muscle fibers.…”

Section: Changes In the Tongue Function In Response To Fp Therapy Andmentioning

confidence: 99%

Effects of Inhaled Fluticasone on Upper Airway during Sleep and Wakefulness in Asthma: A Pilot Study

Teodorescu

Xie

Sorkness

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objective: Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fl uticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness. Study design: 16-week single-arm study. Participants: 18 (14 females, mean [ ± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV 1 89 ± 8% predicted). Interventions: High dose (1,760 mcg/day) inhaled FP. Measurements: (1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure-Pmax, in KPa) and endurance-time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot)-at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects. Results: Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H 2 O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved. Conclusions: In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined. S C I E N T I F I C I N V E S T I G A T I O N SG rowing evidence suggests that asthma patients have an increased predisposition for obstructive sleep apnea (OSA). Studies consistently fi nd higher prevalence of OSA symptoms among asthma patients.1-5 In a 14-year longitudinal study, asthma emerged as an independent risk factor for incident habitual snoring when adjusting for relevant confounders, including body mass index (BMI) at baseline and its change in time.6 Likewise, the prevalence of OSA diagnosed on polysomnography (PSG) is high (88% to 95.5%) in diffi cult-to-control asthma, 7,8 and follows asthma severity with 58% in moderate asthma versus 12% in controls. 7The mechanisms underlying this increased risk for OSA in asthma remain unknown. Apart from traditional OSA risk factors, BRIEF SUMMARYCurrent Knowledge/Study Rationale: Obstructive sleep apnea is more prevalent among people with asthma of increasing severity, but underlying mechanisms remain unknown. Inhaled corticosteroids may play a role. Study Impact: Sixteen-week treatment with inhaled fl uticasone elicited individual responses in upper airway collapsibility depe...

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“…Various studies have been conducted assessing the association between ICS and the occurrence of oral candidiasis [9][10][11][12]. One review reported incidence rates between 0 and 70 %, based on four studies performed between 1974 and 1990 using different diagnostic criteria [2].…”

Section: Introductionmentioning

confidence: 99%

Inhaled Corticosteroids and the Occurrence of Oral Candidiasis: A Prescription Sequence Symmetry Analysis

2013

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Objectives The primary aim of the study was to gain insight into the relative risk of clinically relevant oral candidiasis following inhaled corticosteroid (ICS) initiation over time. A secondary aim was to analyse the influence of patient characteristics and co-medication on the occurrence of this adverse effect. Methods Drug prescription data from 1994 to 2011 were retrieved from the IADB.nl database. To study the influence of ICS use on occurrence of oral candidiasis, a prescription symmetry analysis was used, including patients using medication for oral candidiasis up to 1 year before or after ICS initiation. The relative risk was calculated by dividing the number of patients receiving medication for oral candidiasis after ICS initiation by the number of patients receiving the same medication before ICS initiation. Sub-analyses were conducted to compare the relative risks at several time points after ICS initiation and to account for therapy persistence by only including chronic users of ICS. A multivariate logistic regression model was used to identify predictive factors. Results A total of 52,279 incident users of ICS therapy were identified, of which 1,081 received medication for oral candidiasis up to 1 year before or after ICS initiation. A total of 701 patients received medication for oral candidiasis after ICS initiation, while 361 received these medications in the reversed sequence, resulting in a sequence ratio (SR) of 1.94 (95 % CI 1.71-2.21). In the first 3 months after ICS initiation, the SR was 2.72 (95 % CI 2.19-3.38) and then decreased to 1.47 (95 % CI 1.11-1.95) 9-12 months after ICS initiation. Predictive factors were higher daily dose of ICS and concomitant use of oral corticosteroids. Conclusions This study found a significant and clinically relevant increased number of patients receiving medication for oral candidiasis in the first year after therapy initiation with ICS. Relative risk is highest in the first 3 months, but remains increased up to at least 1 year after ICS initiation. This study stresses the need for patient education and inhalation instruction.

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Local side‐effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device

Abstract: Local side-effects of ICS are common in asthmatic children of all ages, and the device used constitutes the most influential factor.

Cited by 152 publications

References 27 publications

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Effects of Inhaled Fluticasone on Upper Airway during Sleep and Wakefulness in Asthma: A Pilot Study

Inhaled Corticosteroids and the Occurrence of Oral Candidiasis: A Prescription Sequence Symmetry Analysis

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