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The Wrath of Steroids in Elderly Patients with Pulmonary Diseases

  • Pulmonology and Respiratory Care (A Musani and E Folch, Section Editors)
  • Published:
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Abstract

Pulmonary diseases such as Chronic Obstructive Pulmonary Disease (COPD) and asthma are common in the elderly population. Corticosteroids, systemic and inhaled, are commonly used in their treatment. There are many adverse effects associated with corticosteroid treatment. These include cataracts, osteoporosis, diabetes mellitus, and delirium, which are more common and more dangerous in the elderly population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Global strategy for the diagnosis, management, and prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2016. Available at: www.goldcopd.org (Accessed 12/29/2015). Up to date recommendations for diagnosis and management of COPD.

  2. Heron M. Deaths: leading causes for 2012. Natl Vital Stat Rep. 2015;64(10):1–94.

    Google Scholar 

  3. Centers for Disease Control and Prevention (CDC). Chronic obstructive pulmonary disease among adults—United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61(46):938–43.

    Google Scholar 

  4. Scichilone N, Pedone C, Battaglia S, et al. Diagnosis and management of asthma in the elderly. Eur J Intern Med. 2014;25(4):336–42.

    Article  PubMed  Google Scholar 

  5. Oraka E, Kim HJ, King ME, Callahan DB. Asthma prevalence among US elderly by age groups: age still matters. J Asthma. 2012;49(6):593–9.

    Article  PubMed  Google Scholar 

  6. Global strategy for asthma management and prevention. Global Initiative for Asthma (GINA). 2015. Available at: http://www.ginaasthma.org (Accessed 12/29/2015). Up to date recommendations for diagnosis and management of asthma

  7. Battaglia S, Cardillo I, Lavorini F, et al. Safety consideration of inhaled corticosteroids in the elderly. Drugs Aging. 2014;31:787–96.

    Article  CAS  PubMed  Google Scholar 

  8. Mattishent K, Thavarajah M, Blanco P, et al. Meta-review: adverse effects of inhaled corticosteroids relevant to older patients. Drugs. 2014;74:539–47. Recent meta-analysis for adverse effects of inhaled corticosteroids.

    Article  CAS  PubMed  Google Scholar 

  9. McEvoy CE, Niewoehner DE. Adverse effects of corticosteroid therapy for COPD: a critical review. Chest. 1997;111:732–43.

    Article  CAS  PubMed  Google Scholar 

  10. Fardet L, Abdulrhaman K, Cabane J, et al. Corticosteroid-induced adverse events in adults: frequency screening and prevention. Drug Saf. 2007;30(10):861–81.

    Article  CAS  PubMed  Google Scholar 

  11. Fardet L, Cabane J, Lebbe C, et al. Incidence and risk factors for corticosteroid induced lipodystrophy: a prospective study. J Am Acad Dermatol. 2007;57(4):604–9.

    Article  PubMed  Google Scholar 

  12. Fardet L, Flahault A, Kettaneh A, et al. Corticosteroid-induced clinical adverse events: frequency, risk factors and patient’s opinion. Br J Dermatol. 2007;157(1):142–8.

    Article  CAS  PubMed  Google Scholar 

  13. Nguyen H, Lim J, Dresner ML, et al. Effect of local corticosteroids on early inflammatory function in surgical wounds of rats. J Foot Surg. 1998;37:313–8.

    Article  CAS  Google Scholar 

  14. Chen HL, Shen WQ, Yang-Hui X, et al. Perioperative corticosteroids administration as a risk factor for pressure ulcers in cardiovascular surgical patients: a retrospective study. Int Wound J. 2015;12(5):581–5. Recent study showing increased risk for surgically related pressure ulcers in those receiving perioperative corticosteroids.

    Article  PubMed  Google Scholar 

  15. Karagas MR, Cushing Jr GL, Greenberg ER, et al. Non-melanoma skin cancers and glucocorticoid therapy. Br J Cancer. 2001;85(5):683–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jensen AO, Thomsen HF, Engebjerg MC, et al. Use of oral glucocorticoids and risk of skin cancer and non-Hodgkin’s lymphoma: a population based case-control study. Br J Cancer. 2009;100:200–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Capewell S, Reynolds S, Shuttleworth D, Edwards C, Finlay AY. Purpura and dermal thinning associated with high dose inhaled corticosteroids. BMJ. 1990;300:1548–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Black RL, Oglesby RB, Von Sallmann L, Bunim JL. Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA. 1960;174:166–71.

    Article  CAS  PubMed  Google Scholar 

  19. Walsh LJ, Wong CA, Oborne J, et al. Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax. 2001;56:279–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Weatherall M, Clay J, James K, Perrin K, Shirtcliffe P, Beasley R. Dose-response relationship of inhaled corticosteroids and cataracts: a systemic review and meta-analysis. Respirology. 2009;14:983–90.

    Article  PubMed  Google Scholar 

  21. Lloyd-Jones D, Adams RJ, Brown TM, et al. Executive summary: heart disease and stroke statistics 2010 update: a report from the American Heart Association. Circulation. 2010;121(7):948–54.

    Article  PubMed  Google Scholar 

  22. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004;141:764–70.

    Article  PubMed  Google Scholar 

  23. Christiansen CF, Christensen S, Mehnert F, et al. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case control study. Arch Intern Med. 2009;169(18):1677–83.

    Article  PubMed  Google Scholar 

  24. Gennari FJ. Hypokalemia. N Engl J Med. 1998;339:451–8.

    Article  CAS  PubMed  Google Scholar 

  25. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991;115:787–96.

    Article  CAS  PubMed  Google Scholar 

  26. Van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002;13:888–87.

    Article  Google Scholar 

  27. Suissa S, Baltzan M, Kremer R, et al. Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care Med. 2004;169:83–8.

    Article  PubMed  Google Scholar 

  28. Mortimer KJ, Tata LJ, Smith CJP, et al. Oral and inhaled corticosteroids and adrenal insufficiency: a case-control study. Thorax. 2006;61:405–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Todd GR, Acerini CL, Ross-Russell R, et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child. 2002;87:457–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Gulliford MC, Charlton J, Latinovic R. Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care. 2006;29:2728–9.

    Article  CAS  PubMed  Google Scholar 

  31. Donihi AC, Raval D, Saul M, et al. Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients. Endocr Pract. 2006;12:358–62.

    Article  PubMed  Google Scholar 

  32. Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med. 2010;123:1001–6.

    Article  CAS  PubMed  Google Scholar 

  33. Lewis DA, Smith RE. Steroid-induced psychiatric syndromes. J Affect Disord. 1983;5:319–32.

    Article  CAS  PubMed  Google Scholar 

  34. Fardet L, Petersen I, Nazareth I. Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry. 2012;169(5):491–7.

    Article  PubMed  Google Scholar 

  35. Kennan PA, Jacobson MW, Soleymani RM, et al. The effect of chronic prednisone treatment in patients with systemic disease. Neurology. 1996;47(6):1396–402.

    Article  Google Scholar 

  36. Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954–63.

    Article  CAS  PubMed  Google Scholar 

  37. Kew K, Seniukovic A. Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014;3:CD010115. Cochrane review of parallel randomized control trials of at least 12 weeks duration comparing fluticasone or budesonide, either alone or with long acting beta-agonist, against placebo or long acting beta-agonist alone. Examined 26 fluticasone studies and 17 budesonide studies concluding that both increase risk for pneumonia.

    PubMed  Google Scholar 

  38. Singh S, Loke YK. An overview of the benefits and drawbacks of inhaled corticosteroids in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulm Dis. 2010;5:189–95.

    Article  CAS  Google Scholar 

  39. Fardet L, Cabane J, Eettaneh A, et al. Corticosteroid induced lipodystrophy is associated with features of the metabolic syndrome. Rheumatology. 2007;46:1102–6.

    Article  CAS  PubMed  Google Scholar 

  40. Da Silva JA, Jacobs JW, Kirway JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis. 2006;65(3):285–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Roy A, Le Blanc C, Paquete L, et al. Skin bruising in asthmatic subjects treated with high doses of inhaled steroids: frequency in association with adrenal function. Eur Respir J. 1996;9:226–31.

    Article  CAS  PubMed  Google Scholar 

  42. Oglesby RB, Black RL, von Sallmann L, Bunim JJ. Cataracts in patients with rheumatic diseases treated with corticosteroids. Arch Ophthalmol. 1961;66:41–6.

    Google Scholar 

  43. Rooklin AR, Lampert SI, Jaeger EA, McGeady SJ, Mansmann Jr HC. Posterior subcapsular cataracts in steroid requiring asthmatic children. J Allergy Clin Immunol. 1979;63:383–6.

    Article  CAS  PubMed  Google Scholar 

  44. Leibold JE, Itkin IH. Cataracts in asthmatics treated with corticosteroids. JAMA. 1963;185:448.

    Article  CAS  PubMed  Google Scholar 

  45. Urban Jr RC, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986;31:102–10.

    Article  CAS  PubMed  Google Scholar 

  46. Tripathi RC, Parapuran SK, Tripathi BJ, et al. Corticosteroids and glaucoma risk. Drugs Aging. 1999;1:439–50.

    Article  Google Scholar 

  47. Toogood JH, Markov AE, Baskerville J, Dyson C. Association of ocular cataracts with inhaled and oral steroid therapy during long term treatment of asthma. J Allergy Clin Immunol. 1993;91:571–9.

    Article  CAS  PubMed  Google Scholar 

  48. Simons FE, Persaud MP, Gillespie CA, Cheang M, Shuckett EP. Absence of posterior subcapsular cataracts in young patients treated with inhaled glucocorticoids. Lancet. 1993;342:776–8.

    Article  CAS  PubMed  Google Scholar 

  49. Reed CE, Offord KP, Nelson HS, et al. Aerosol beclomethasone dipropionate spray compared with theophylline as primary treatment for chronic mild to moderate asthma. J Allergy Clin Immunol. 1998;101:14–23.

    Article  CAS  PubMed  Google Scholar 

  50. Garbe E, Suissa S, LeLorier J. Association of inhaled corticosteroid use with cataract extraction in elderly patients. JAMA. 1998;280:539–43.

    Article  CAS  PubMed  Google Scholar 

  51. Smeeth L, Boulis M, Hubbard R, Fletcher AE. A population based case-control study of cataract and inhaled corticosteroids. Br J Ophthalmol. 2003;87:1247–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Garbe E, LeLorier J, Boivin JF, Suissa S. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open angle glaucoma. JAMA. 1997;277:722–7.

    Article  CAS  PubMed  Google Scholar 

  53. Souverein PC, Berard A, Van Staa TP, et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart. 2004;90:859–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Varas-Lorenzo C, Rodriguez LAG, Maguire A, et al. Use of oral corticosteroids and the risk of acute myocardial infarction. Atherosclerosis. 2007;192:376–83.

    Article  CAS  PubMed  Google Scholar 

  55. Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med. 1994;236:619–32.

    Article  CAS  PubMed  Google Scholar 

  56. Sato A, Funder JW, Okubo M, et al. Glucocorticoid-induced hypertension in the elderly. Relation to serum calcium and family history of essential hypertension. Am J Hypertens. 1995;8(8):823–8.

    Article  CAS  PubMed  Google Scholar 

  57. Morris GC, Egan JG, Keston JM. Hypokalemic paralysis induced by bolus prednisolone in Graves’ disease. Aust NZ J Med. 1992;22(3):312.

    Article  CAS  Google Scholar 

  58. Messer J, Reitman D, Sacks HS, et al. Association of adrenocorticosteroid therapy and peptic ulcer disease. N Engl J Med. 1983;309(1):21–4.

    Article  CAS  PubMed  Google Scholar 

  59. Piper JM, Ray WA, Daughter JR, et al. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114(9):735–40.

    Article  CAS  PubMed  Google Scholar 

  60. Boyer SL, LaMothe MP, Hollister JR. Steroid myopathy: incidence and detection in a population with asthma. J Allergy Clin Immunol. 1985;76:234–42.

    Article  Google Scholar 

  61. Ferrando AA, Stuart CA, Sheffiedl-Moore M, et al. Inactivity amplifies the catabolic response of skeletal muscle to cortisol. J Clin Endocrinol Metab. 1999;84:3515–21.

    CAS  PubMed  Google Scholar 

  62. Horber FF, Scheidegger JR, Grunig BE, et al. Evidence that prednisone-induced myopathy is reversed by physical training. J Clin Endocrinol Metab. 1985;61(1):83–8.

    Article  CAS  PubMed  Google Scholar 

  63. Langhammer A, Forsmo S, Syversen U. Long-term therapy in COPD: any evidence of adverse effect on bone? Int J Chron Obstruct Pulmon Dis. 2009;4:365–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Leslie WD, Lix LM, Langsetmo L, et al. Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int. 2011;22(3):817–27.

    Article  CAS  PubMed  Google Scholar 

  65. Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000;15:933–1000.

    Google Scholar 

  66. De Vries F, Bracke M, Leufkens HG, et al. Fracture risk with intermittent high dose oral glucocorticoid therapy. Arthritis Rheum. 2007;56:208–14.

    Article  PubMed  CAS  Google Scholar 

  67. Grossman JM, Gordan R, Ranganath VK, et al. American college of rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 2010;62(11):1515–26.

    Article  Google Scholar 

  68. Hubbard R, Smith C, Smeeth L, et al. Inhaled corticosteroids and hip fracture: a population based case control study. Am J Respir Crit Care Med. 2002;166:1563–6.

    Article  PubMed  Google Scholar 

  69. Loke YK, Cavallazzi R, Singh S. Risk of fractures with inhaled corticosteroids in COPD: systemic review and meta-analysis of randomized controlled trials and observational studies. Thorax. 2011;66:699–708.

    Article  PubMed  Google Scholar 

  70. Poetker DM, Reh DD. A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin N Am. 2010;43(4):753–68.

    Article  Google Scholar 

  71. Fraser CG, Preuss FR, Bigford WD. Adrenal atrophy and irreversible shock associated with cortisone therapy. JAMA. 1952;149:1542–3.

    Article  CAS  Google Scholar 

  72. Schlaghecke R, Kornely E, Santen RT, et al. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med. 1992;326:226–30.

    Article  CAS  PubMed  Google Scholar 

  73. Henzen C, Suter A, Lerch E, et al. Suppression and recovery of adrenal response after short term, high dose glucocorticoid treatment. Lancet. 2002;355:542–5.

    Article  Google Scholar 

  74. Marik PE, Varon J. Requirement of perioperative stress doses of corticosteroids: a systemic review of the literature. Arch Surg. 2008;143(12):1222–6.

    Article  CAS  PubMed  Google Scholar 

  75. Grahnen A, Eckernas SA, Brundin RM, et al. An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers. Br J Clin Pharmacol. 1994;38:521–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Clark DJ, Grove A, Cargill RI, et al. Comparative adrenal suppression with inhaled budesonide and fluticasone propionate in adult asthmatic patients. Thorax. 1996;51:262–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Masoli M, Weatherall M, Holt S, et al. Inhaled fluticasone propionate and adrenal effects in adult asthma: systemic review and meta-analysis. Eur Respir J. 2006;28:960–7.

    Article  CAS  PubMed  Google Scholar 

  78. Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: a systemic review and meta-analysis. Arch Intern Med. 1999;159(9):941–55.

    Article  CAS  PubMed  Google Scholar 

  79. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care. 2008;31:596–615.

    Article  Google Scholar 

  80. Zhang X, Decker FH, Luo H, et al. Trend in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58(4):724–30.

    Article  PubMed  Google Scholar 

  81. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, HTN, and cardiovascular disease in COPD. Eur Respir J. 2008;32:962–9.

    Article  CAS  PubMed  Google Scholar 

  82. Sarnes E, Crofford L, Watson M, et al. Incidence and US costs of corticosteroid-associated adverse events: a systemic literature review. Clin Ther. 2011;33(10):1413–32.

    Article  PubMed  Google Scholar 

  83. Gurwitz J, Bohn R, Glynn R, Monane M, Mogun H, Avorn J. Glucocorticoids and the risk of initiation of hypoglycemic therapy. Arch Intern Med. 1994;154:97–101.

    Article  CAS  PubMed  Google Scholar 

  84. Blackburn D, Hux J, Mamdani M. Quantification of the risk of corticosteroid induced diabetes mellitus among the elderly. J Gen Intern Med. 2002;17:717–20.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Kim SY, Yoo CG, Lee CT, et al. Incidence and risk factors of steroid induced diabetes in patients with respiratory disease. J Korean Med Sci. 2011;26:264–7.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Tamez-Perez HE, Quintanilla-Flores DL, Rodriguez-Gutierrez R, et al. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes. 2015;6(8):1073–81.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Fong AC, Cheng NW. The high incidence of steroid induced hyperglycaemia in hospital. Diabetes Res Clin Pract. 2013;99:277–80. Prospective protocol for chart review of patients receiving high dose corticosteroids while hospitalized showing high incidence of steroid induced hyperglycemia.

    Article  CAS  PubMed  Google Scholar 

  88. Calverly PM, Anderson JA, Celli B, et al. TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.

    Article  Google Scholar 

  89. O’Byrne PM, Rennard S, Gerstein H, Radner F, et al. Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaled corticosteroids. Respir Med. 2012;106:1487–93.

    Article  PubMed  Google Scholar 

  90. Dendukuri N, Blais L, LeLorier J. Inhaled corticosteroids and the risk of diabetes among the elderly. Br J Clin Pharmacol. 2002;54:59–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Flynn RW, MacDonald TM, Hapca A, et al. Quantifying the real life risk profile of inhaled corticosteroid in COPD by record linkage analysis. Respir Res. 2014;15(141):1–8. Recent cohort study from Scotland of 4305 subjects examining risk of ICS on diabetes mellitus, pneumonia, hospitalizations for fractures, and cataract extraction.

    Google Scholar 

  92. Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim care companion J Clin Psychiatry. 2001;3(1):17–21.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Wolkowitz OM, Burke H, Epel ES, et al. Glucocorticoids. Mood, memory and mechanisms. Ann N Y Acad Sci. 2009;1179:19–40.

    Article  CAS  PubMed  Google Scholar 

  94. The Boston Collaborative Drug Surveillance Program. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther. 1972;13:694–8.

    Article  Google Scholar 

  95. Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8 days’ corticosteroid treatment: a prospective study. Psychoneuroendocrinology. 1996;21:25–31.

    Article  CAS  PubMed  Google Scholar 

  96. Hall RC, Popkin MK, Stickney SK, et al. Presentation of the steroid psychoses. J Nerv Ment Dis. 1979;167:229–36.

    Article  CAS  PubMed  Google Scholar 

  97. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006;81:1361–7.

    Article  CAS  PubMed  Google Scholar 

  98. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002;2(11):659–66.

    Article  PubMed  Google Scholar 

  99. Dowell SF, Bresee JS. Severe varicella associated with steroid use. Pediatrics. 1993;92:223–8.

    CAS  PubMed  Google Scholar 

  100. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med. 1994;96:115–23.

    Article  CAS  PubMed  Google Scholar 

  101. Jick SS, Liberman ES, Rahan MU, et al. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 2006;55:19–26.

    Article  PubMed  Google Scholar 

  102. Lionaki MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet. 2003;362:1828–38.

    Article  CAS  Google Scholar 

  103. Davidson RA, Fletcher RH, Chapman LE. Risk factors for strongyloidiasis: a case control study. Arch Intern Med. 1984;144(2):321–4.

    Article  CAS  PubMed  Google Scholar 

  104. Sakuma Y, Katoh T, Owada K, et al. Initial functional status predicts infections during steroid therapy for renal diseases. Clin Nephrol. 2005;63(2):68–73.

    Article  CAS  PubMed  Google Scholar 

  105. Calverly P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomized controlled trial. Lancet. 2003;361(9356):449–56.

    Article  Google Scholar 

  106. Wunderink RG, Waterer GW. Community-acquired pneumonia. N Engl J Med. 2014;370:543–51.

    Article  CAS  PubMed  Google Scholar 

  107. Suissa S, Patenaude V, Lapi F, et al. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013;68:1029–36.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Dong YH, Chang CH, Lin Wu FL, et al. Use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza: a systemic review and meta-analysis of randomized controlled trials. Chest. 2014;145(6):1286–97.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge that assistance of H Raff PhD in guiding the creation of this manuscript.

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Correspondence to Angela K. Beckert.

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Angela Beckert declares that she has no conflict of interest.

Edmund Duthie reports grants from Reynolds Foundation, Health Services Resources Administration, Elsevier, and the American Board of Internal Medicine.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pulmonology and Respiratory Care

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Beckert, A.K., Duthie, E.H. The Wrath of Steroids in Elderly Patients with Pulmonary Diseases. Curr Geri Rep 5, 124–131 (2016). https://doi.org/10.1007/s13670-016-0171-z

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