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Vol. 29. Issue 3.
Pages 109-115 (April 1993)
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Vol. 29. Issue 3.
Pages 109-115 (April 1993)
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Yatrogenia de la terapéutica corticoidea y de los corticoides inhalados en el tratamiento de los enfermos respiratorios
Iatrogenesis of corticoid therapy and inhaled corticoids in the treatment of patients with respiratory disease
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M. Luengo Planas, C. Picado Vallés
Servei de Pneumologia. Hospital Clínic. Facultat de Medicina. Barcelona
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Es bien conocido que el tratamiento continuo con glucocorticoides se asocia en un número considerable de pacientes a múltiples efectos secundarios. A lo largo de su historia, y dado que son agentes con una potencia antiinflamatoria muy importante, han sufrido variaciones en cuanto a su prescripción, pasando de una utilización demasiado “generosa” lo que provocaba la aparición de efectos secundarios importantes, a una restricción de su uso, a veces, más de lo médicamente necesario. Actualmente, sus indicaciones y pautas de administración están bien establecidas, y aunque la yatrogenia existe y en algunos casos produciendo una morbilidad importante, la larga lista de efectos secundarios se reducen a unos pocos, entre los que destacan: 1. Osteopenia (disminución de la masa ósea) con aumento en la prevalencia de fracturas fundamentalmente vertebrales. 2. Cataratas, en su localización subcapsular posterior. 3. Miopatía. 4. Alteraciones cutáneas (púrpura y adelgazamiento de la dermis).

Long term treatment with glucocorticoids is associated with multiple secondary effects in an appreciable number of patients. This is why throughout their history these drugs, as therapeutic agents, have undergone variations in regards to use, due, on one hand, to their important therapeutic action making their usage too “generous” in some diseases, and on the other hand, to the appearance of side effects of considerable importance which restricted their use to less than what may have been medically necessary. At present, the indications and schedules of administration are well established and although iatrogenesis exists, and in some cases produces signiflcant morbidity, tlie long list of secondary effects has been reduced to only a few, such as osteopenia with an increase in the prevalence of vertebral fractures, formation of posterior subcapsular cataracts, myopathy and cutaneous alterations (purpura and thinning of the dermis).

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Bibliografía
[1.]
J.P. Seale, M.R. Compton.
Side-effects of corticosteroid agents.
Med JAust, 144 (1986), pp. 139-142
[2.]
B.E.C. Nordin, R.G. Crilly, D.A. Smith.
Osteoporosis.
Metabolic bone and stone disease, 2.a ed, pp. 1-70
[3.]
R.P. Heaney.
Calcium bone health and osteoporosis.
Bone mineral research/4, pp. 255-301
[4.]
S.P. Nielsen, B. Krolner.
Photonbeam absorptiometry Osteoporosis a multidisciplinary problem, pp. 105-108
[5.]
L.V. Avioli.
Effects of chronic corticosteroid therapy on mineral metabolism and calcium absorption.
pp. 81-89
[6.]
T.J. Hahn.
Corticosteroid-induced osteopenia.
Arch Intern Med, 138 (1978), pp. 882-885
[7.]
T.J. Hahn, V.C. Boisseau, L.V. Avioli.
Effect of chronic corticosteroid administration on diaphyseal and metaphyseal bone mass.
J Clin Endocrinol Metab, 39 (1974), pp. 274-282
[8.]
A.D. Adinoff, J.R. Hollister.
Steroid-induced fractures and bone loss in patients with asthma.
N EngI J Med, 309 (1983), pp. 265-268
[9.]
D.M. Reid, J.J. Nicoll, M.A. Smith, B. Higgins, P. Tothill, G. Nuki.
Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polimyalgia rheumatica.
Br Med J, 293 (1986), pp. 1.463-1.466
[10.]
M. Luengo Planas.
Contribución al estudio de la osteoporosis esteroidea en el asma bronquial corticodependiente, (1989),
[11.]
M. Luengo, C. Picado, L. Del Río, et al.
Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study.
Thorax, 46 (1991), pp. 803-806
[12.]
E.N. Coomes.
Corticosteroid myopathy.
Ann Rheum Dis, 24 (1965), pp. 465-472
[13.]
C. Picado, J.A. Fiz, J.M. Montserrat, et al.
Respiratory and skeletal muscle function in steroid-dependent bronchial asthma.
Am Rev Respir Dis, 141 (1990), pp. 14-20
[14.]
R.L. Black, R.B. Oglesby, I. Von Sallman, et al.
Posterior supcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis.
JAMA, 174 (1960), pp. 166-171
[15.]
H.W. Skalka, J.T. Prchal.
Effect of corticosteroid on cataract formation.
Arch Ophthalm, 98 (1980), pp. 1.373-1.377
[16.]
S. Capewell, S. Reynolds, D. Shuttleworth, C. Edwards, A.Y. Finlay.
Purpura and dermal thinning associated with high dose inhaled corticosteroids.
Br Med J, 300 (1990), pp. 1.548-1.551
[17.]
Conference report.
Consensus development conference: prophylaxis and treatment of osteoporosis.
Br Med J, 295 (1987), pp. 914-915
[18.]
R. Smith.
Corticosteroids and osteoporosis.
Thorax, 45 (1990), pp. 573-578
[19.]
I.R. Reid, A.R. King, C.J. Alexander, H.K. Ibbertson.
Prevention of steroid-induced osteoporosis with 3-amino-l-hydroxypropylide-ne-l,l-bisphosphonate (APD).
Lancet, (1988), pp. 143-147
[20.]
M. Luengo, C. Picado, L. Del Río, N. Guañabens, J.M. Montserrat, J. Setoain.
Treatment of steroid-induced osteopenia with calcitonin in corticosteroid-dependent asthma. A one year follow-up study.
Am Rev Respir Dis, 142 (1990), pp. 104-107
Copyright © 1993. Sociedad Española de Neumología y Cirugía Torácica
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