Guidelines praise inhaled corticos...

Guidelines praise inhaled corticosteroids for patients with harsh chronic obstructive pulmonary disease (COPD) to attenuate the number of exacerbations and improve health status. Systemic corticosteroids have been shown to negatively affect bone density, increasing the risk for osteoporosis and fractures, although data are inconsistent. single complication is that chronic disease is a risk factor for fracture, and patients with COPD have a 36 to 60 percent increased risk of osteoporosis because of the lung disease. Johannes and associates assessed the risk of nonvertebral fractures in relation to inhaled corticosteroids in adults with COPD

The nest case-control contemplation included patients with COPD or asthma who were enlisted in a large insurance program. Inclusion criteria were an age of at least 40 years, enrollment in the health plan for at least 12 month and at least couple claims for outpatient physician visits or united inpatient claim. Eligible participants who had a first-time treated nonvertebral fracture were included in the final analysis. A direct group also was randomly pick outed from the database. Exposure to inhaled corticosteroids was established using pharmacy claims. The cumulative dose was estimated at multiplying the number of containers in each dispensing by the agency of the number of doses through container, then multiplying by the force of the medication. The patients' inhaled corticosteroid outlooks were calculated at one, three six, and 12 month before the fracture claim or before the random index date assigned to the have charge of group. The patients were then divided into four categories (i.e., extremely low, low, medium, and high average daily dosages).

Within the cohort of 89877 patients with insurance claims for COPD asthma, or the one and the other 1,722 were eligible for the fracture dispose and 17,220 were in the direction group. The most common fracture sites were lower and upper limbs. Approximately 35 percent of patients in the pair groups were using inhaled corticosteroids, and approximately 27 percent were taking oral corticosteroids. After analyzing for fracture risk, the authors place no increased risk for patients using inhaled corticosteroids. The findings were the same when comparing different dosages.

The authors finish that patients using inhaled corticosteroids are at no higher risk for nonvertebral fracture than those who do not use them. They caution that the arises in patients receiving high dosages were highly variable because not many patients were included in this category. The touch about the potential increase of fracture risk should not obstruct physicians from prescribing inhaled corticosteroids for patients with COPD

KARL E MILLER, MD

Johannes CB et al. The risk of nonvertebral fracture related to inhaled corticosteroid aspect among adults with chronic respiratory disease. Chest January 2005;127:89-97

COPYRIGHT 2005 American Academy of Family Physicians

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