Joint Position Statement Of The Asthma Committees Of The Canadian Thoracic Society And The Canadian Society Of Allergy And Clinical Immunology
On Intraocular Pressure And Inhaled Glucocorticosteroids
An epidemiological study (JAMA vol. 277, no. 9, pp. 722-727, March 97) has suggested that the use of high-doses of inhaled corticosteroids is associated with a slightly increased risk of development of increased intraocular pressure and glaucoma. However, the risk difference between this large group of inhaled corticosteroid users and controls was just statistically significant and made in patients aged 65 years of age or older, in whom glaucoma is more likely to occur than in younger people. As the study's authors stated, there is no overall relationship between inhaled corticosteroid use and glaucoma. The borderline association described in a small subset of patients taking high-doses of inhaled corticosteroids must therefore be regarded as preliminary findings and require further study before their significance is clear.
Inhaled corticosteroids are widely used world-wide and are considered the best treatment for asthma. Previous reports had shown that inhaled corticosteroids (even at low doses) afforded a significant protection against severe/lethal asthma deaths. If this medication is stopped or reduced in those whose respiratory condition is controlled with these agents there is a risk of asthma worsening, sometimes becoming potentially severe.
The recently reported study should therefore not prevent those using this type of treatment from taking them regularly according to medical recommendations. We advise all those using these agents to continue their treatment according to their physicians' recommendations and if they have any concern, to discuss those with them. Monitoring of intraocular pressure may be warranted in patients of the age group reported who need unusually high doses of inhaled corticosteroids so that there is early detection and treatment if required. Patients requiring very high doses of inhaled corticosteroids to control asthma should also ideally be receiving asthma care by a specialist.
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