Adverse effects of oral corticosteroids in relation to dose in patients with lung disease
Open Access
- 1 April 2001
- Vol. 56 (4) , 279-284
- https://doi.org/10.1136/thorax.56.4.279
Abstract
BACKGROUND The adverse effects of oral corticosteroids are widely recognised but there are few quantitative data on which to base advice to patients. In a two part cross sectional study we compared adverse effects in patients with lung disease taking oral corticosteroids and control subjects and related the adverse effects to corticosteroid dose in the patient group. METHODS Data on oral corticosteroid use, lifestyle, fractures, and other possible adverse effects were collected by questionnaire and compared between a community based cohort of patients taking continuous or frequent intermittent oral corticosteroids for asthma, chronic obstructive pulmonary disease, or alveolitis and age and sex matched control subjects. Dose related effects were explored in the corticosteroid group using cumulative dose quartiles and multiple logistic regression. RESULTS A total of 367 patients (⩾50 years, 48% female) and 734 control subjects completed the questionnaire. The cumulative incidence of fractures since the time of diagnosis was 23% for patients taking oral corticosteroids and 15% in the control group (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.3 to 2.6). Patients were more likely to have had a fracture of the vertebrae (OR 10; 95% CI 2.9 to 34), hip (OR 6; 95% CI 1.2 to 30), and ribs or sternum (OR 3.2, 95% CI 1.6 to 6.6) than control subjects. They also reported a significant increase in cataracts, use of antacids, muscle weakness, back pain, bruising, oral candidiasis, and having fewer teeth. The effects of oral corticosteroids were dose related: the odds ratio for patients in the highest compared with the lowest cumulative dose quartile (median prednisolone dose 61 g versus 5 g) ranged from 2 for all fractures to 9 for vertebral fractures and bruising. CONCLUSIONS By quantifying the morbidity associated with the use of oral corticosteroids, this study should help to rationalise their long term use.Keywords
This publication has 18 references indexed in Scilit:
- Timing of first fillings in the primary dentition and permanent first molars of asthmatic childrenActa Odontologica Scandinavica, 1998
- Risk for periodontal disease in patients with longstanding rheumatoid arthritisArthritis & Rheumatism, 1997
- Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitisThe Lancet, 1996
- Rheumatoid arthritis, corticosteroid therapy and hip fracture.Annals of the Rheumatic Diseases, 1995
- What Does the Odds Ratio Estimate in a Case-Control Study?International Journal of Epidemiology, 1993
- Prevalence of Adverse Effects in Corticosteroid Dependent AsthmaticsAllergy and Asthma Proceedings, 1988
- Steroid-Induced Fractures and Bone Loss in Patients with AsthmaNew England Journal of Medicine, 1983
- Complications of long-term steroid therapy for asthmaJournal of Allergy and Clinical Immunology, 1972
- Long-term Steroid Therapy in Chronic Intractable AsthmaBMJ, 1962
- STEROIDS IN THE LONG-TERM TREATMENT OF ASTHMAThe Lancet, 1961