Allergy & Asthma Associates of Southern California, Southern California Research, Mission Viejo, California.
The Breathing Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
Ann Allergy Asthma Immunol. 2016 Dec;117(6):589-594. doi: 10.1016/j.anai.2016.06.017.
Inhaled corticosteroids (ICSs) effectively deliver corticosteroids to target sites in the lungs and reduce systemic effects compared with oral corticosteroids, but long-term systemic exposure from inhaled corticosteroids remains a concern.
To discuss ICS systemic effects on the eye and the hypothalamic-pituitary-adrenal (HPA) axis.
Relevant publications were used to augment discussion.
The most common adverse effects of exogenous corticosteroids on the eye are secondary open-angle glaucoma and posterior subcapsular cataracts. Study findings conflict about whether ICS use is associated with increased risk of glaucoma or elevated intraocular pressure, but studies might not have addressed the question in the right population. Increased risk of glaucoma may be limited to a few susceptible individuals, such as individuals with a family history of glaucoma. Large population-based studies reveal that high daily doses or high lifetime exposure of ICSs is associated with a higher risk of posterior subcapsular cataracts. More research is needed to determine the risk from low to moderate doses during long periods. For the HPA axis, there are several measures for detecting systemic effects. Short-term measures are more sensitive for detecting the systemic effects of ICSs but have less predictive value in identifying clinically important adverse effects. Several studies have found that ICSs have a dose-dependent effects on cortisol suppression that can be used to estimate equivalent dosages among ICSs.
Because of systemic effects on the HPA axis, high doses of ICS should be avoided where possible. Adult patients undergoing high-dose or long-term ICS therapy should be monitored for cataracts.
与口服皮质类固醇相比，吸入皮质类固醇（ICS）可将皮质类固醇有效递送至肺部的靶位，并降低全身作用，但吸入皮质类固醇的长期全身暴露仍然令人担忧。
讨论 ICS 对眼睛和下丘脑-垂体-肾上腺（HPA）轴的全身作用。
使用相关出版物来补充讨论。
外源性皮质类固醇对眼睛最常见的不良反应是继发性开角型青光眼和后囊下白内障。研究结果对于 ICS 使用是否与青光眼或眼内压升高的风险增加相关存在冲突，但这些研究可能没有在合适的人群中解决这个问题。青光眼的风险可能仅限于少数易感个体，例如有青光眼家族史的个体。大型基于人群的研究表明，高每日剂量或高终生 ICS 暴露与后囊下白内障的风险增加相关。需要更多的研究来确定长期使用低至中等剂量时的风险。对于 HPA 轴，有几种检测全身作用的方法。短期措施对于检测 ICS 的全身作用更敏感，但在识别临床上重要的不良反应方面预测价值较低。几项研究发现，ICS 对皮质醇抑制具有剂量依赖性作用，可用于估计 ICS 之间的等效剂量。
由于对 HPA 轴的全身作用，应尽可能避免高剂量的 ICS。接受高剂量或长期 ICS 治疗的成年患者应监测白内障。
