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Medical Forum / Diseases and Disorders / Asthma / February 2006

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cataracts and inhaled corticosteroids

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windwatcher - 22 Feb 2006 01:11 GMT
The most recent post on this subject I found here from a post in 1999.
Met a woman today who used flonase and rhinocort for three or four
years, age around 50 - 55, and had two cataracts recently operated
upon. I took (until today) Nasocort and Advair and Singulair.  Would
anyone be willing to renew some interest in this subject.  For example,
is Advair considered an inhaled corticosteroid; I think it is.
Singulair: apparently safe.  Is it worth the risk: I find it difficult
to believe, unless the asthma is truly life-threatening.  Mine has been
under control for several years thanks to regular use of these
medicines.  Seriously considering using just the albuterol inhalr and
the nebulizer, neither of which have received much usage but appear to
be safer.  Any opinions would be Greatly appreciated.
00doc - 22 Feb 2006 01:57 GMT
> The most recent post on this subject I found here from a post in 1999.
> Met a woman today who used flonase and rhinocort for three or four
[quoted text clipped - 8 lines]
> the nebulizer, neither of which have received much usage but appear to
> be safer.  Any opinions would be Greatly appreciated.

Advair definately contains an inhaled steroid  - no "considering"  about it.
Steroid use, either inhaled or oral, does pedispose to cataracts. I've not
heard that nasal steroids do but it would not surprise me. You do have to
keep in mind a few things:

1) It is one risk factor among many. Some people use high doses for decades
and never get a cataracts. Some get cataracts without ever using steroids.
It would always be hard to tell in any individual person whether they would
have gotten the cataracts without the steroids; especially if you do not
know about her other risk factors. FWIW 5 years of a nasal steroids is not
much of an exposure so my bet would be that she got the cataracts at least
partly, if not completely, due to other factors.

2) Whatever risk does exist must be compared to the risk of not taking the
meds for people with the disease, not to the risk of not taking the meds to
people who don't have it. Cataracts is not fatal and is correctable by a
safe and effective surgery (so safe that even cardiac patients can have it
done with no pre-operative testing). Not being able to breath is fatal at
worst, limiting at best, and can't be fixed after the fact if you later
realise you screwed it up.

3) People do die of asthma (as opposed to cataracts). It is not always
obvious in advance that it is "life threatening". Inhaled sterids have been
shown to reduce permanent lung damage, prevent exacerbations, reduce ER
visits and hospitalizations, improve quality of life, and reduce mortality
in asthma patients. What is dangerous is for an asthmatic to take regular
frequent doses of albuterol without an inhaled steroid.

4) You need to refine your search skills. This is a fairly frequent topic of
conversation. I found posts on this group discussing cataracts from April
2005 and the effects of inhaled steroids on death rates in August of 2005
and I only tried one search term for each.

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