Summary of Included Studies on Adverse Events of Inhaled Corticosteroids in COPD
| Author, Year | N | Design | Population | Results | Quality Rating |
|---|---|---|---|---|---|
| COPD = chronic obstructive pulmonary disease; NA = not applicable; BDP = beclomethasone dipropionate; BMD – bone mineral density; ICS = inhaled corticosteroid; RCT = randomized controlled trial; BUD = budesonide; PSC = posterior subcapsular cataracts; RAMQ = regi de l’assurance maladie du Quebec database; GPRD = general practice research database; IOP = intraocular pressure. | |||||
| Bone density and osteoporotic fractures | |||||
| Jones et al,30 2004 | NA | Systematic review | Asthma and COPD | No difference in BMD and osteoporotic fractures between ICS and placebo | Fair |
| Hubbard et al,31 2002 | 16,341 | Case-control | Asthma and COPD | Nonspecific ICS use associated with a small increase in the risk of hip fracture | Good |
| Israel et al,32 2001 | 109 | Prospective cohort | Women (aged 18–45 y) | Triamcinolone associated with dose- related decline in BMD (total hip and trochanter) of 0.00044 g/cm2 per puff/year | Fair |
| Johnell et al,33 2002 | 1,277 | RCT | COPD | No difference in bone density between BUD and placebo over 3 y; no difference in bone density or vertebral fractures in subgroup of 912 smokers | Fair |
| Lee & Weiss,34 2004 | 8,525 | Nested case-control | COPD | Nonspecific ICS use associated with increased risk of fractures at high doses | Good |
| Posterior subcapsular cataracts | |||||
| Cumming et al,35 1997 | 3,654 | Cross-sectional | Adults; asthma and COPD; aged 49–97 y | Increased risk of nuclear and PSC among ICS users | N/A |
| Garbe et al,36 1998 | 25,545 | Case-control | RAMQ; asthma and COPD; aged ≥70 y | Increased risk of cataract extraction for ICS users only at high dose and duration | Good |
| Jick et al,37 2001 | 201,816 (3,581) | Cohort + case-control | GPRD; asthma and COPD; aged 3–90 y | Dose-, duration-, and age-related increased risk of cataracts among ICS users; no increase in risk for age <40 | Good |
| Smeeth et al,38 2003 | 30,958 | Case-control | GPRD; asthma and COPD; aged ≥40 y | Dose- and duration-related increased risk of cataracts among ICS users | Good |
| Ocular hypertension and open-angle glaucoma | |||||
| Garbe et al,39 1997 | 48,118 | Case-control | RAMQ aged ≥66 y | ≥3 mo high-dose ICS associated with increased risk of open-angle glaucoma and ocular hypertension | Fair |
| Mitchell et al,40 1999 | 3,654 | Cross-sectional | Adults; asthma and COPD; aged 49–97 y | Dose-related increased risk of elevated IOP and open-angle glaucoma for ICS users with glaucoma family history | N/A |