Cost-effectiveness of inhaled steroids in asthma: Impact of effect on bone miner

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JACI Highlights - February 2006

Fuhlbrigge et al – Cost-effectiveness of inhaled steroids in asthma: Impact

of effect on bone mineral density

National guidelines recommend inhaled corticosteroids (ICS) as first-line

therapy in persistent asthma. Yet, widespread non-adherence on the part of

physicians and patients to these guidelines persists. This may be due, in part,

to concerns about the safety of ICS.

The link between ICS use and potential changes in Bone Mineral Density (BMD)

has not been established with certainty because studies have yielded

conflicting results.

Therefore, the aim of the study by Fuhlbrigge and colleagues in the February

2006 issue of the Journal of Allergy and Clinical Immunology was to assemble

the existing evidence and provide guidance about the appropriateness of ICS

therapy in persistent disease.

They found that although the economic attractiveness of ICS therapy is

dependent on assumptions regarding the impact of ICS on BMD and resultant

fracture

rate, ICS therapy in mild/moderate asthma compares favorably with commonly

accepted interventions, over a wide range of assumptions regarding this

treatment. Because of the potential impact of high doses of ICS over prolonged

periods, risk can be minimized by utilizing the lowest effective dose and by

identifying high-risk individuals for appropriate intervention.