Title: Adverse effects of long-term corticosteroid use in asthma: systematic review
Funder: Asthma UK

Abstract: Steroid inhalers are commonly used worldwide for treating asthma. However, they can cause side effects such as bone fractures, eye diseases (glaucoma or cataracts), and poor growth in children. We need to be aware of the risk factors for these unwanted effects and take steps to prevent them happening. A better understanding of the side effects of steroids is a top priority for patients and doctors / nurses. At present, there is a lack of reliable information regarding this matter. Therefore, an up-to-date review of the existing data will help patients and doctors / nurses to better understand the risks so that they can make more informed decisions regarding treatment of asthma. Our review will look at how likely it is for a side effect to happen, and how it depends on the following factors: type of steroid and how it is given (inhaler or tablet), the dose given, how often it is used and for how long, and whether certain patients are more likely to suffer side effects than others. Our Aim We are going to do a review of the available evidence regarding the major side effects of steroid inhalers. First, we will take a look at other reviews that have been done. After that, we will look at the data from clinical trials and / or other studies to see if there are any major side effects which have not been included in existing reviews. However, data from clinical trials usually does not show information regarding which patients are more likely to suffer side effects, or whether the side effect depend on the strength of steroid inhaler used. This is because such trials normally only look at a specific strength of steroids (rather than a wide range of doses), and the trials often leave out patients who are considered at high risk of suffering side effects. How we choose the studies to include in our review The existing studies we will look at are as follows: 1) Existing systematic reviews of side effects 2) Clinical trials of steroids used for longer than 1 year 3) Studies that observe steroid users, compared to those who don’t use steroids All the studies we look at will involve either children or adults with asthma who use steroids either as tablets or inhalers. They can compare two different steroid inhalers, or compare patients who use steroids inhalers with those who do not use steroid inhalers (or are users of steroid tablets). The side effects we are looking for are bone fractures, the eye diseases glaucoma or cataract, glands not producing important hormones, and pneumonia. How we find the studies to include in our review We have already developed a reliable method for finding studies that contain information regarding side effects, using certain keywords. Therefore, we will be using this method in our review. We will also look at government websites and websites of companies who make steroid inhalers. What information we are collecting We will note down the key features of how each study was carried out and what the patients were like. We will also take note of the type of steroid used, the dose, and how it was given and how long it was used for. How we make sure the results are accurate When we look at clinical trials, we will examine how the decision on which patient would use a steroid inhaler was made, as well as whether the patient and doctor / nurse involved was aware of that decision beforehand. For other types of studies, we will look at how they chose the patients to be included in the studies. We will note down how each study determined the side effects and how those side effects were monitored. How we produce our results If it is possible, we will combine the results of the studies using a statistical method known as a meta-analysis (pooling the data together). Otherwise, we will make a list of the results and compare them in a critical manner. How we distribute our findings We will publish our review in a medical journal that can be read on the website by members


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;6.1 PHARMACEUTICALS
Health categories: RESPIRATORY