Dear Editor

Asthma is a potentially life threatening condition with an ever increasing morbidity and mortality internationally, the prevalence of asthma having increased approximately 50% over the last ten to 15 years. Death rates are proportional to the usage of anti-inflammatory medications effectively.According to the asthma audit in UK too incidence measured was 3 to 4 times higher in adults and 6 times higher in children than it was 25 years ago. In 2000, GPs in the UK saw over 18,000 cases relating to new asthma attacks each week.Currently 1500 people still die from asthma each year in UK alone.Many more do in the rest of the world. Many of these deaths might have been prevented with adequate routine and emergency care. The risk of cataract as determined by Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington was negligible under the age of 40.Moreover there is conclusive evidence that the risk increases significantly only after 3 years. Cataracts due to steroids tend to be posterior subcapsular in morphology.Such cataracts are rarely seen in children who were administered inhaled steroids.[3,4] Newer steroids like budesonide may further reduce the risk with dosages upto 6 years.[5] In addition, individual susceptibility plays a role in affecting risk.[6] Hence the need for a prospective double blind study with a good follow up cannot be undermined. It would be highly erroneous to presume potentially life saving drugs especially useful in children as risky on the basis of a retrospective analysis that too statistical.It would further be incorrect to comment on the risk of cataract formation without having a look at the type of cataract which is formed and the effect of the drug on the rate of formation of the characteristic cataract without taking into consideration individual susceptibility; thus undermining its use in peadiatric population where it is relatively safe and the benefits far overweigh the risks especially with newer steroids.

References

(1) Jick SS, Vasilakis-Scaramozza C, Maier WC. The risk of cataract among users of inhaled steroids. Epidemiology. 2001 Mar;12(2):229-34.

(2) Garbe E, Suissa S, LeLorier J.Association of inhaled corticosteroid use with cataract extraction in elderly patients.JAMA. 1998 Aug 12;280(6):539- 43.

(3) 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 Feb;91(2):571-9.

(4) Simons FE, Persaud MP, Gillespie CA, Cheang M, Shuckett EP. Absence of posterior subcapsular cataracts in young patients treated with inhaled glucocorticoids. Lancet. 1993 Sep 25;342(8874):776-8.

(5) Agertoft L, Larsen FE, Pedersen S.Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide. Eur Respir J. 1998 Jul;12(1):130-5.

(6) Barenholtz H. Effect of inhaled corticosteroids on the risk of cataract formation in patients with steroid- dependent asthma. Ann Pharmacother. 1996 Nov;30(11):1324-7.

(7)Abuekteish F, Kirkpatrick JN, Russell G. Posterior subcapsular cataract and inhaled corticosteroid therapy. Thorax. 1995 Jun;50(6):674-6.