Effect of inhaled corticosteroids on the risk of cataract formation in patients with steroid-dependent asthma.

Compared with daily oral corticosteroid use, inhaled corticosteroids decrease the risk of cataract formation in patients with steroid-dependent asthma. Compared with alternate-day corticosteroid use, inhaled corticosteroids appear to pose a similar or slightly decreased risk of developing PSC. The use of long-term inhaled corticosteroids appears to be a relatively safe alternative regarding cataract formation; however, the addition of oral corticosteroids as pulse therapy or in any pattern of regular use can increase the risk of PSC development. Rare pulse therapy may have little impact, but more data are needed to evaluate this issue. In addition, individual susceptibility likely plays a role in affecting risk, but concomitant use of corticosteroids administered via nasal inhalation appears to have no impact on the risk. Clinicians might consider the potential benefit of escalated dosing of inhaled steroids over oral pulse therapy for certain clinical situations; however, more research is necessary. More data also are needed on the role of individual susceptibility.