How Safe Are Inhaled Corticosteroids for Patients with Asthma?

Inhaled corticosteroids (ICS) are the backbone of asthma therapy, but higher doses have been associated with adverse effects such as thrush, dysphonia, pneumonia, and decreased bone mineralization. Although 80% to 90% of the maximum benefit of ICS can be obtained with low doses, many patients are placed on high doses with little consideration of adverse effects.

Researchers used U.K. databases to study 160,000 adults with asthma, including 96,000 who initiated ICS. One year of ICS use at medium or high doses was associated with significant excess risk for major adverse cardiac events (hazard ratios, 2.6 for medium doses and 4.6 for high doses), arrhythmia (2.2 and 2.9), pulmonary embolus (2.1 and 3.3), and pneumonia (2.3 and 4.1). No excess …