The side effects of corticosteroids range from minor to severe and life threatening. The nature and severity of side effects depend on the route, dose, and frequency of administration, as well as the specific agent used. Side effects are much more prevalent with systemic administration than with inhalant administration. The potential consequences of systemic administration of the corti-costeroids include adrenal suppression, cushingoid changes, growth retardation, cataracts, osteoporosis, CNS effects and behavioral disturbances, and increased susceptibility to infection. The severity of all of these side effects can be reduced markedly by alternate-day therapy.
Inhaled corticosteroids are generally well tolerated. In contrast to systemically administered corticosteroids, inhaled agents are either poorly absorbed or rapidly metabolized and inactivated and thus have greatly diminished systemic effects relative to oral agents. The most frequent side effects are local; they include oral candidiasis, dysphonia, sore throat and throat irritation, and coughing. Special delivery systems (e.g., devices with spacers) can minimize these side effects. Some studies have associated slowing of growth in children with the use of high-dose inhaled corticosteroids, although the results are controversial. Regardless, the purported effect is small and is likely outweighed by the benefit of control of the symptoms of asthma.
Care should be taken in transferring patients from systemic to aerosol corticosteroids, as deaths due to adrenal insufficiency have been reported. In addition, allergic conditions, such as rhinitis, conjunctivitis, and eczema, previously controlled by systemic corticos-teroids, may be unmasked when asthmatic patients are switched from systemic to inhaled corticosteroids. Caution should be exercised when taking cortico-steroids during pregnancy, as glucocorticoids are terato-genic. Systemic corticosteroids are contraindicated in patients with systemic fungal infections.
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