Use of high-dose inhaled corticosteroids and risk of corticosteroid-related adverse events in asthma findings from the NORDSTAR cohortQuantify Research, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Respiratory Medicine, Copenhagen University Hospital—Hvidovre, Hvidovre, Denmark; Institute of clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
GSK, Helsinki, Finland.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. AstraZeneca, Stockholm, Sweden.
Sanofi, Helsinki, Finland.
Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Otorhinolaryngology Head & Neck surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
Department of Pulmonary Medicine, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia.
Heart and Lung Center, Department of Respiratory Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Severe Asthma Center, Department of Respiratory Medicine and Allergy, Huddinge, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Clinical Lung and Allergy Research Unit, Karolinska Institutet, Stockholm, Sweden.
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
Department of Respiratory Diseases and Allergy, Aarhus University hospital, Aarhus, Denmark.
Severe Asthma Center, Department of Respiratory Medicine and Allergy, Huddinge, Karolinska University Hospital, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Show others and affiliations
2025 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 13, no 7, p. 1609-1619.eArticle in journal (Refereed) Published
Abstract [en]
Background: The link between the use of oral corticosteroids (OCS) and adverse events (AEs) in asthma is well described. In contrast, whether the use of high-dose inhaled corticosteroids (ICS) poses a risk to these is unknown.
Objective: To examine the association between ICS exposure and corticosteroid (CS)-related AEs.
Methods: We conducted an observational cohort study using nationwide Swedish registry data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration. We included patients with asthma aged ≥18 years between 2009 and 2019 and calculated their current ICS exposure and average daily ICS dose (budesonide equivalent) in follow-up. The association between ICS exposure and CS-related AEs was analyzed using Cox proportional hazards models adjusting for age, sex, and OCS dose.
Results: We included 529,203 patients with asthma. Overall, we observed increased hazard ratios (HRs) in those exposed to high-dose (≥800-1599 μg) and very high dose (≥1600 μg) ICS for several AEs, including cardiovascular disease, type 2 diabetes mellitus (T2DM), osteoporosis, and pneumonia compared with those not exposed to ICS. HRs for the current use of high-dose ICS ranged from 1.11 (95% confidence interval [CI]: 1.06-1.16) for T2DM to 1.65 (95% CI: 1.58-1.72) for pneumonia. Likewise, HRs linked to average daily high-dose ICS ranged from 1.16 (95% CI: 1.02-1.33) for pneumonia to 1.70 (95% CI: 1.38-2.08) for osteoporosis. Sensitivity analysis excluding patients using OCS showed that high-dose ICS was still associated with an increased risk of CS-related AEs. Overall, ICS <800 μg per day had no increased risk, except for cataract.
Conclusion: High-dose ICS is associated with an increased risk of several CS-related AEs. This highlights the importance of clinicians considering this risk in patients treated with high-dose and very high dose ICS.
Place, publisher, year, edition, pages
2025. Vol. 13, no 7, p. 1609-1619.e
Keywords [en]
Adverse events, Asthma, Asthma management, Cardiovascular disease, Cataract, Inhaled corticosteroids, Oral corticosteroids, Osteoporosis, Severe asthma, Type 2 diabetes mellitus
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-236241DOI: 10.1016/j.jaip.2025.01.023PubMedID: 39900241Scopus ID: 2-s2.0-85219042895OAI: oai:DiVA.org:umu-236241DiVA, id: diva2:1948833
2025-04-012025-04-012025-07-11Bibliographically approved