Adverse Effects of Asthma Treatment

Introduction to Adverse Effects

The American Academy of Allergy, Asthma, and Immunology recommends that low-dose inhaled corticosteroids are generally safe, but adverse effects increase significantly with high doses and prolonged use, particularly affecting growth in children and bone mineral density in adults 1
The American Academy of Family Physicians notes that oral candidiasis is the most common local adverse effect of inhaled corticosteroids, which can be minimized by rinsing the mouth after each use and using spacers 2

The American Thoracic Society guidelines state that reduction in linear growth rate is the most concerning systemic adverse effect in children, increasing with higher doses of ICS 1, 4
The National Asthma Education and Prevention Program recommends that most children treated with ICS achieve their predicted adult heights, although there may be temporary growth delay 4
The American College of Chest Physicians notes that long-term data indicate that the effects of ICS on growth are a class effect, applicable to all ICS preparations 4, 5

The FDA has issued a black box warning for all LABA due to increased risk of asthma-related events, including death, when used as monotherapy without an inhaled corticosteroid 2
The American Academy of Allergy, Asthma, and Immunology recommends that LABA should not be used as monotherapy, but rather in combination with an inhaled corticosteroid 2
The National Institutes of Health notes that genetic variations in the beta-adrenergic receptor in some ethnic populations, particularly blacks, may reduce the effectiveness of LABA 2

The FDA has issued a black box warning for omalizumab due to a small risk of anaphylaxis (0.09% in post-marketing surveillance studies) 1
The American Academy of Allergy, Asthma, and Immunology recommends that physicians administering omalizumab should be prepared and equipped to treat anaphylaxis, observe patients for an appropriate period after each injection, and educate patients about the risks of anaphylaxis and appropriate treatment 1, 7

The American Academy of Allergy, Asthma, and Immunology notes that zileuton requires monitoring of liver function due to the risk of hepatotoxicity 1
The National Asthma Education and Prevention Program recommends that leukotriene modifiers are generally well-tolerated but less effective than ICS 3

The American Thoracic Society guidelines state that monitoring of serum theophylline concentration is mandatory, maintaining levels between 5-15 mcg/mL 1, 3

The National Institutes of Health recommends that rescue courses of oral corticosteroids may be needed at any step of treatment to control exacerbations 7
The American Academy of Pediatrics notes that recommended doses are 30-60 mg of prednisolone immediately, continuing each morning until two days after control is established in adults, and 1-2 mg/kg of body weight for 1-5 days in children, with no need for gradual reduction 7, 2

The American Academy of Allergy, Asthma, and Immunology recommends that it is as important to reduce medication in patients with well-controlled asthma as it is to increase it in those with uncontrolled asthma, to balance benefits against risks of adverse effects 1
The National Asthma Education and Prevention Program notes that patient concerns about long-term use of corticosteroids can affect their adherence to the prescribed regimen, requiring appropriate education 1