Many patients perceive numerous side effects of inhaled corticosteroids

Abstract

Background:

Side effects of inhaled corticosteroids (ICS) are often described in the literature as infrequent and of minor consequence to patients' health. However, little is known about patients' perceptions of side effects related to ICS use.

Methods:

From the transcripts of 12 in-depth interviews and 2 focus groups (n=22, 68% male, mean age 54) we documented 57 potential side effects that patients associated with their ICS medication which were subsequently put onto a 7 point Likert scale questionnaire (Inhaled Corticosteroids Questionnaire (ICQ)). The ICQ was administered to patients recruited through community pharmacies in Aberdeen, Scotland, and Groningen, The Netherlands. Patients using ICS (low 400μg; mid 401-800μg; or high >800μg dose BDP equivalent daily) or using ß2-agonist inhaler without ICS were eligible. Analysis was performed using the Jonckheere-Terpstra Test (differences between 4 medication groups) and multiple regression (main and 2 way interactive effects of dosage group, age, gender, post inhalation mouth rinsing and smoking on side effect scoring).

Results:

395 patients participated (mean age 50, 53% female), 329 using ICS (400μg, n=109; 401-800μg, n=151; >800μg, n=69; BDP equivalent daily) and 66 using a ß2-agonist inhaler without ICS. Almost half of all ICS users were affected by 10 or more side effects of a moderate amount or greater. 45 patient perceived side effect items including hoarseness, inability to sing, oral thrush, dental decline, skin atrophy, and vision affected showed a statistically significant difference between medication groups (all p<0.05). A clear ICS dose-response existed for nearly all 45 items. Multiple regression showed that dosage pre-eminently influenced side effect perception in 42 of 57 items of the ICQ when categorised into 8 side effect domains.

Conclusion:

Patients perceive numerous side effects of ICS, which are predominantly dose dependent. This reinforces the need for a dose titration strategy in clinical practice to achieve optimal clinical benefit at the lowest dose of inhaled corticosteroids.