Adverse effects of oral corticosteroids in relation to dose in patients with lung disease

Background-The adverse effects of oral corticosteroids are widely recognise d but there are few quantitative data on which to base advice to patients. In a two part cross sectional study we compared adverse effects in patients with lung disease taking oral corticosteroids and control subjects and rel ated the adverse effects to corticosteroid dose in the patient group. Methods-Data on oral corticosteroid use, lifestyle, fractures, and other po ssible adverse effects were collected by questionnaire and compared between a community based cohort of patients taking continuous or frequent intermi ttent oral corticosteroids for asthma, chronic obstructive pulmonary diseas e, or alveolitis and age and sex matched control subjects. Dose related eff ects were explored in the corticosteroid group using cumulative dose quarti les and multiple logistic regression. Results-A total of 367 patients (greater than or equal to 50 years, 48% fem ale) and 734 control subjects completed the questionnaire. The cumulative i ncidence of fractures since the time of diagnosis was 23% for patients taki ng oral corticosteroids and 15% in the control group (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.3 to 2.6). Patients were more likely to have had a fracture of the vertebrae (OR 10; 95% CI 2.9 to 34), hip (OR 6; 95% CI 1.2 to 30), and ribs or sternum (OR 3.2, 95% CI 1.6 to 6.6) than control subjects. They also reported a significant increase in cataracts, use of a ntacids, muscle weakness, back pain, bruising, oral candidiasis, and having fewer teeth. The effects of oral corticosteroids were dose related: the od ds ratio for patients in the highest compared with the lowest cumulative do se quartile (median prednisolone dose 61 g versus 5 g) ranged from 2 for al l fractures to 9 for vertebral fractures and bruising. Conclusions-By quantifying the morbidity associated with the use of oral co rticosteroids, this study should help to rationalise their long term use.