At least two expert panel members independently extracted the data from each study into predefined forms. Information on methods for measuring side-effects and for analysis and on study limitations was extracted. A third panel member checked approximately 40% of the studies to ensure the quality of the evidence abstraction.
ICS use is not associated with a reduction in bone density in children (Grade A evidence). Adults with asthma do not usually show a significant reduction in bone mineral density after ICS treatment, although the effect may become clinically important in patients using high-dose ICSs for many years (Grade C evidence).
The risk of subcapsular and nuclear cataracts associated with ICS is negligible in young people with asthma, but may be greater in older people (Grade C evidence). There was insufficient evidence to assess differences in the risk of cataract formation for the different ICS formulations. The dose-effect relationship between ICS use and cataract formation is not well understood (Grade F evidence).
The risk of glaucoma associated with ICS use is probably small, but further study is needed (Grade F evidence). There was insufficient evidence to assess differences in the risk of glaucoma between different ICS formulations (Grade F evidence). There appears to be a poorly studied dose-effect relationship between ICS use and glaucoma (Grade F evidence).
ICS use is associated with a reduction in short-term growth rates in children, but the overall effect is small and may not be sustained with long-term therapy (Grade A evidence). The adult height of asthmatic children treated with ICS is no different from that of non-asthmatic adults (Grade C evidence). There is not enough information about the difference between steroid formulations to draw definitive conclusions regarding their relative effects on growth (Grade C evidence).
ICS use is associated with an increased risk of skin thinning and easy bruising. Dose, duration of use, and gender can affect overall risk (Grade B evidence). There was insufficient information to assess differences in the risk of skin thinning or easy bruising for the different ICS formulations (Grade F evidence). There appears to be a dose-effect relationship between ICS use and skin thinning or easy bruising.