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(Chest. 2003;124:2329-2340.)
© 2003 American College of Chest Physicians

Systematic Review of the Evidence Regarding Potential Complications of Inhaled Corticosteroid Use in Asthma*

Collaboration of American College of Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and American College of Allergy, Asthma, and Immunology

Frank T. Leone, MD, MS, FCCP; James E. Fish, MD, FCCP{dagger}; Stanley J. Szefler, MD and Suzanne L. West, PhD; for the Expert Panel on Corticosteroid Use{dagger}

* From Thomas Jefferson University (Dr. Leone), Philadelphia, PA; Aventis Pharmaceuticals (Dr. Fish), Bridgewater, NJ; National Jewish Medical and Research Center (Dr. Szefler), Denver, CO; and the University of North Carolina (Dr. West), Chapel Hill, NC. {dagger} This work was performed while Dr. Fish was on the faculty of Thomas Jefferson University. {ddagger} See Appendix for list of members of the Expert Panel on Inhaled Corticosteroid Use.

Correspondence to: Frank T. Leone, MD, MS, FCCP, Jefferson Medical College, 1015 Chestnut St, Suite M100, Philadelphia, PA 19107; e-mail: frank.leone{at}mail.tju.edu

Introduction: The available clinical guidelines have been successful in improving awareness of the inflammatory nature of asthma and have promoted the use of inhaled corticosteroids (ICSs) to achieve long-term control of symptoms. Because of lingering concerns over the possible adverse consequences of ICS use, an expert panel was convened with a mandate to identify the critical questions that impact decisions regarding the use of ICSs and to evaluate the available evidence with respect to risk

Methods: A university librarian retrieved citations and abstracts from the MEDLINE and EMBASE databases using a list of National Library of Medicine search terms and key words. Reviewers were asked to systematically abstract relevant information from each of their assigned articles and to list their own clinical or scientific conclusions based on the study results. A predefined grading algorithm was used to calculate a summary quality rating score for the relevant evidence

Results: The results are presented as a series of key questions followed by a summary of the relevant evidence. An evidence grade is assigned, followed by a summary statement reflecting the panel’s consensus opinion following review.

Conclusions: The preponderance of evidence supports a conclusion that the proven clinical effectiveness of ICS treatment decidedly outweighs the proven risks.

Key Words: asthma • bone density • cataracts • complications • evidence-based • glaucoma • growth retardation • inhaled corticosteroids • skin thinning




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