Systemic side effects of inhaled corticosteroids in patients with asthma

Respir Med. 2006 Aug;100(8):1307-17. doi: 10.1016/j.rmed.2005.11.020. Epub 2006 Jan 18.


Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / adverse effects*
  • Adrenal Insufficiency / chemically induced
  • Adult
  • Anti-Allergic Agents / adverse effects
  • Asthma / drug therapy*
  • Bone Density / drug effects
  • Cataract / chemically induced
  • Child
  • Child Development / drug effects
  • Contusions / chemically induced
  • Glaucoma / chemically induced
  • Humans
  • Hydrocortisone / blood
  • Hydrocortisone / urine
  • Hypothalamo-Hypophyseal System / drug effects
  • Osteoporosis / chemically induced
  • Pituitary-Adrenal System / drug effects
  • Pregnenediones / adverse effects
  • Skin Diseases / chemically induced


  • Adrenal Cortex Hormones
  • Anti-Allergic Agents
  • Pregnenediones
  • ciclesonide
  • Hydrocortisone