Inhaled corticosteroids increase risk of cataracts

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Nearly a decade ago, inhaled corticosteroids were seen as a major advance in the treatment of asthma. At the time, researchers had discovered that asthma is an inflammatory disease, not solely one of bronchial constriction. Inhaled steroids were expected to treat the underlying inflammatory process and revolutionize the care of asthmatics without the usual adverse effects associated with oral steroids such as the development of cataracts. A new study, however, has found a link between long-term use of inhaled steroids and cataracts (The New England Journal of Medicine, 3 July 1997). Many of the participants were using beclomethasone, sold in the U.S. under a variety of brand names such as Beclovent, Beconase, and Vanceril.

Robert G. Cumming, Ph.D., and colleagues at the University of Sydney, Sydney, Australia, recruited over 3,600 people, aged 49 to 97 years, from a community-based clinic near Sydney. Among them were 370 people who were either currently using inhaled steroids or had used them in the past. Most important, none of the 370 had ever taken oral steroids. These participants had a higher prevalence of cataracts than did the others who never used inhaled steroids. Furthermore, the higher the doses taken and the longer the use, the higher the incidence of the most visually disabling type of cataract, called posterior subcapsular cataracts. Dr. Cumming and colleagues called for more research to replicate their findings. Previous studies involved a small number of participants or children for whom cataracts would be rare. The Australian trial is the first to involve a substantial number of older adults.

What should people with asthma do? They should do everything they can to lower their risk of developing cataracts, according to Leo T. Chylack, Jr., M.D., Brigham and Women's Hospital, Boston. In an editorial that accompanied the Australian study, he advises people got to smoke, to limit their sun exposure by wearing hats and sunglasses, take a multivitamin tablet daily, and eat at least three servings per day of fresh fruit or green leafy vegetables. (A higher intake of antioxidants--beta carotene, vitamins C and E--either as food or dietary supplements is linked to a lower rate of cataracts and macular degeneration. See HealthFacts, January 1995.) Despite their potential side-effects, Dr. Chylack wrote, "long-term use of inhaled corticosteroids will sometimes be the best treatment for a patient's asthma."

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