Specialty medical societies offer evidence-based conclusions on inhaled steroid treatment for asthma

December 08, 2003

(NORTHBROOK, IL, December 9, 2003) - Inhaled corticosteroid (ICS) therapy remains the gold standard of asthma treatment, according to findings from a systematic evidence review released today by the American College of Chest Physicians (ACCP), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI). Published in the December issue of CHEST, the peer-reviewed journal of the ACCP, the review offers evidence-based conclusions on several prominent risks associated with ICS therapy for the treatment of adult and pediatric asthma.

"ICS therapy has been the gold standard in asthma treatment for 20 years because of its proven effectiveness. However, since the inception of ICS therapy, physicians have been concerned about side effects, particularly in special populations, such as children, women, and the elderly," said lead author Frank T. Leone, MD, MS, FCCP, Thomas Jefferson University, Philadelphia, PA. "After a systematic and accurate review of the proven risks, we can say with confidence that the majority of evidence supports the conclusion that the clinical effectiveness of ICS therapy decidedly outweighs the proven risks."

An expert panel with representatives from the ACCP, the AAAAI, and the ACAAI identified critical questions that impact decisions regarding the use of ICS therapy in relation to the five adult and pediatric risk areas of bone mineral density (BMD), cataracts, glaucoma, growth retardation, and skin thinning. Panel members reviewed 108 asthma studies related to ICS therapy complications and summarized all relevant evidence for each risk area. A consensus statement was provided for each risk area along with a grade to reflect the quantity and quality of evidence supporting each conclusion. Overall, the panel concluded that the benefits associated with ICS use greatly exceed the risks. In regards to the effect of ICS therapy on BMD, the panel strongly supported the conclusion that ICS use is not associated with a reduction in BMD in children with asthma. The panel also supported the conclusion that ICS use is associated with skin thinning and easy bruising in adults and children, but that dose, duration of use, and patient gender are important variables affecting overall risk. In addition, the panel fully supported the conclusion that ICS therapy is associated with a decrease in short-term growth rates in children, but that the overall effect is small and may not be sustained with long-term therapy. According to the panel, conclusions regarding the effect of ICS therapy on BMD in adults and the effect of ICS therapy on the development of cataracts and glaucoma were insubstantial because they were only supported by conflicting or insufficient data.

"With more than 15 million people in the United states living with asthma, adverse events related to asthma therapy can greatly impact public health," said Richard S. Irwin, MD, FCCP, President of the American College of Chest Physicians. "The joint effort between the ACCP, AAAAI, and ACAAI to provide physicians with conclusions on the risks of ICS use signifies the continuous support of evidence-based medicine by these medical societies and their commitment to patient-focused care."
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CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. ACCP represents more than 15,700 members who provide clinical, respiratory, and cardiothoracic patient care in the United States and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.

The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the Academy has nearly 6,000 members in the United States, Canada and 60 other countries. The Academy serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org.

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization, headquartered in Arlington Heights, Illinois, comprising 4,963 qualified allergists-immunologists and related health-care professionals. The ACAAI is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

American College of Chest Physicians

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