Adverse Effects Common With
Glucocorticoids In Adolescents
James Adams / DGReview 1nov00
High-dose inhaled glucocorticoids and oral glucocorticoids are associated
with a high number of adverse effects in adolescents with severe asthma,
research shows.
Investigators reviewed the charts of 163 children aged nine or older with
difficult-to-control asthma who were consecutively admitted to the National
Jewish Medical and Research Center in Denver, Colorado.
The children were mostly adolescents of mean age 14.4 ± 2.1 years. They were
receiving high-dose inhaled glucocorticoids and averaged six systemic
glucocorticoid bursts per year. Half were receiving chronic oral glucocorticoid
therapy.
Adverse effects associated with glucocorticoid use were common and included
hypertension in 88 percent, cushingoid features in 66 percent, adrenal
suppression in 56 percent, myopathy in 50 percent, osteopenia in 46 percent,
growth suppression in 39 percent, obesity and hypercholesterolemia in 30
percent, and cataracts in 14 percent.
Osteopenia was associated with growth suppression and was more common in females
than in males.
Levels of growth suppression, while still significant, were less severe than in
previous studies published before the introduction of high-dose inhaled
glucocorticoid therapy.
"This observation suggests that high-dose inhaled glucocorticoid therapy,
by affording better asthma control and allowing less use of systemic therapy,
has attenuated the growth-suppressive effects of poorly controlled asthma,"
the researchers suggest.
Adverse effects associated with glucocorticoid use are "still unacceptably
common among children with severe asthma," the researchers conclude.
"Therefore, close monitoring and proper intervention are warranted,"
they stress. "There is clearly a need to consider alternative therapy or
earlier intervention."