• Reviewed on 8/12
    By Dr. Tinkelman

Inhaled Steroids and the Risk of Glaucoma

Inhaled Steroids and Asthma
Adverse Side Effects from Inhaled Steroids
The Risk of Glaucoma with Inhaled Steroids
Learn more about steroid medications, their uses, and complications.


Inhaled Steroids and Asthma

Inhaled steroids are now considered the cornerstone of asthma treatment. The National Institutes of Health released its updated version of the Expert Panel Report on the Guidelines for the Diagnosis and Treatment of Asthma in 2007. This report strongly supports the use of inhaled steroids to reduce and prevent asthma symptoms in people with moderate to severe asthma.


Adverse Side Effects from Inhaled Steroids

The use of high dose inhaled steroids has reduced the need for long term oral steroids in many asthma patients. Doctors have known for many years that long term use of oral steroids (available in tablet or liquid form) has been associated with a greater risk for glaucoma, cataracts and other side effects and they regularly monitor for these adverse effects. Because inhaled steroids are given in small doses directly to the airways and are much less available to the rest of the body, they have a much lower risk for systemic side effects than oral steroids. There are a number of preparations available in different strengths that can be prescribed in a range of low to high doses.

At this time, there is only limited information on adverse side effects from inhaled steroids, especially with higher doses. However, as with any medicine, there is a concern for the potential of adverse effects. Physicians should identify patients who have a greater risk for side effects and use the lowest dose of medicine needed to control the disease. In addition, a number of asthma medicines are available which may be used to reduce the need for high dose inhaled steroids for many patients.


The Risk of Glaucoma with Inhaled Steroids

There has been a recent report raising concerns about the use of high dose inhaled steroids and an increased risk of developing ocular hypertension or glaucoma. Ocular hypertension is high pressure within the eye that can possibly result in partial or complete loss of vision. A recent study reviewed patients over 65 years of age who were referred to an eye specialist and included patients who were taking higher doses of inhaled steroids, including higher than recommended doses. A high dose inhaled steroid was defined as a daily dose exceeding 1500 mcg per day. This is calculated by taking the dose per inhalation for the specific inhaled steroid and multiplying that by the number of inhalations a person takes per day.

The study showed that patients who were on high dose inhaled steroids for longer than three months had a higher risk for developing glaucoma. This study points out that caution should be used with long term use of high dose inhaled steroids in elderly patients. It is important to note, however, that the risk for glaucoma overall increases with age due to the aging process. The study implies that high dose inhaled steroids should be used cautiously in patients who already have glaucoma. It is reassuring that this study noted that people who were taking low to moderate doses of inhaled steroids were not at greater risk for glaucoma.

It is important to remember that many people require routine inhaled and occasional oral steroids to control their asthma. Good asthma control is crucial and inhaled steroids play a major role in asthma management. If you are taking a high dose of an inhaled steroid for more than three months, you may benefit by receiving care from or consulting an asthma specialist. An asthma specialist is experienced with the current asthma medicines, how to adjust the dose of these medicines for their best effect and when to monitor for side effects.

Please talk to your doctor about any concerns you may have with your asthma treatment and possible side effects.


Learn more about steroids medications, their uses and complications.


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