Table 3.

Summary of Included Studies on Adverse Events of Inhaled Corticosteroids in COPD

Author, YearNDesignPopulationResultsQuality 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 2004NASystematic reviewAsthma and COPDNo difference in BMD and osteoporotic fractures between ICS and placeboFair
Hubbard et al,31 200216,341Case-controlAsthma and COPDNonspecific ICS use associated with a small increase in the risk of hip fractureGood
Israel et al,32 2001109Prospective cohortWomen (aged 18–45 y)Triamcinolone associated with dose- related decline in BMD (total hip and trochanter) of 0.00044 g/cm2 per puff/yearFair
Johnell et al,33 20021,277RCTCOPDNo difference in bone density between BUD and placebo over 3 y; no difference in bone density or vertebral fractures in subgroup of 912 smokersFair
Lee & Weiss,34 20048,525Nested case-controlCOPDNonspecific ICS use associated with increased risk of fractures at high dosesGood
Posterior subcapsular cataracts
Cumming et al,35 19973,654Cross-sectionalAdults; asthma and COPD; aged 49–97 yIncreased risk of nuclear and PSC among ICS usersN/A
Garbe et al,36 199825,545Case-controlRAMQ; asthma and COPD; aged ≥70 yIncreased risk of cataract extraction for ICS users only at high dose and durationGood
Jick et al,37 2001201,816 (3,581)Cohort + case-controlGPRD; asthma and COPD; aged 3–90 yDose-, duration-, and age-related increased risk of cataracts among ICS users; no increase in risk for age <40Good
Smeeth et al,38 200330,958Case-controlGPRD; asthma and COPD; aged ≥40 yDose- and duration-related increased risk of cataracts among ICS usersGood
Ocular hypertension and open-angle glaucoma
Garbe et al,39 199748,118Case-controlRAMQ aged ≥66 y≥3 mo high-dose ICS associated with increased risk of open-angle glaucoma and ocular hypertensionFair
Mitchell et al,40 19993,654Cross-sectionalAdults; asthma and COPD; aged 49–97 yDose-related increased risk of elevated IOP and open-angle glaucoma for ICS users with glaucoma family historyN/A