Systematic review of the evidence regarding potential complications of inhaled corticosteroid use in asthma: collaboration of American College of Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and American College of Allergy, Asthma, and Immunology

Chest. 2003 Dec;124(6):2329-40. doi: 10.1378/chest.124.6.2329.


Introduction: The available clinical guidelines have been successful in improving awareness of the inflammatory nature of asthma and have promoted the use of inhaled corticosteroids (ICSs) to achieve long-term control of symptoms. Because of lingering concerns over the possible adverse consequences of ICS use, an expert panel was convened with a mandate to identify the critical questions that impact decisions regarding the use of ICSs and to evaluate the available evidence with respect to risk.

Methods: A university librarian retrieved citations and abstracts from the MEDLINE and EMBASE databases using a list of National Library of Medicine search terms and key words. Reviewers were asked to systematically abstract relevant information from each of their assigned articles and to list their own clinical or scientific conclusions based on the study results. A predefined grading algorithm was used to calculate a summary quality rating score for the relevant evidence.

Results: The results are presented as a series of key questions followed by a summary of the relevant evidence. An evidence grade is assigned, followed by a summary statement reflecting the panel's consensus opinion following review.

Conclusions: The preponderance of evidence supports a conclusion that the proven clinical effectiveness of ICS treatment decidedly outweighs the proven risks.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones* / administration & dosage
  • Adrenal Cortex Hormones* / adverse effects
  • Adrenal Cortex Hormones* / therapeutic use
  • Aged
  • Anti-Asthmatic Agents* / administration & dosage
  • Anti-Asthmatic Agents* / adverse effects
  • Anti-Asthmatic Agents* / therapeutic use
  • Asthma / drug therapy*
  • Bone Density / drug effects
  • Cataract / chemically induced
  • Child
  • Child, Preschool
  • Female
  • Glaucoma / chemically induced
  • Humans
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Risk Assessment


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents