Clinical Side Effects during Aerosol Therapy: Cutaneous and Ocular Effects.
Geller DE.
Nemours Children's Clinic, Orlando, Florida.
Aerosolized medications maximize clinical benefit by targeting the airways and minimize side effects by reducing (though not eliminating) systemic exposure. Aerosolized drugs delivered with a facemask may inadvertently deposit on the face and in the eyes, raising concerns about cutaneous and ocular side effects with these drugs. Cases of anisocoria have been reported from exposure of the eyes to aerosol bronchodilators. Whether inhaled corticosteroids(ICS) can cause skin and eye problems like those seen with systemic or topical steroids is more difficult to answer. Patients who take ICS may have other corticosteroid exposures, or have other conditions that predispose them to side effects, making the analysis of the ICS risk challenging. Also, many studies were not designed to search for cutaneous or ocular effects, or may have been too short to detect these effects. Nevertheless, ICS have been associated with an increased risk of skin thinning, bruising, cataracts and possibly glaucoma in adults, but not in children. The risks increase with advanced age, higher doses, and longer duration of use. In children, the risks of cataracts and glaucoma were negligible with ICS, whether a mouthpiece or a mask interface was used. Side effects like skin rash and conjunctivitis occurred at low frequencies similar to placebo or comparator drugs. We do not know whether exposed children will have increased risks from ICS later in life. Therefore, it is wise to avoid face and eye deposition when possible, and to use the minimally effective dose.
PMID: 17411401 [PubMed - in process]
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Clinical Side Effects during Aerosol Therapy: Cutaneous and Ocular Effects.
Geller DE.
Nemours Children's Clinic, Orlando, Florida.
临床气溶胶吸入疗法时的副作用：皮肤的和眼部的影响
Aerosolized medications maximize clinical benefit by targeting the airways and minimize side effects by reducing (though not eliminating) systemic exposure.
雾化器给药通过气道给药达到最大的临床利益和通过减低（而不是消除）全身性暴露最小的副反应。
Aerosolized drugs delivered with a facemask may inadvertently deposit on the face and in the eyes, raising concerns about cutaneous and ocular side effects with these drugs.
雾化器给药用面罩释放的方式可能不注意地沉积于脸部和眼部，提高这些药物的皮肤和眼部的副反应。
Cases of anisocoria have been reported from exposure of the eyes to aerosol bronchodilators. Whether inhaled corticosteroids(ICS) can cause skin and eye problems like those seen with systemic or topical steroids is more difficult to answer.
暴露于使用气溶胶给支气管扩张剂时双侧瞳孔大小不等的病例已经有报道。像这样对于吸入的的皮质激素是否引起皮肤和眼睛的问题对照于全身或者局部使用是更难回答的。
Patients who take ICS may have other corticosteroid exposures, or have other conditions that predispose them to side effects, making the analysis of the ICS risk challenging. Also, many studies were not designed to search for cutaneous or ocular effects, or may have been too short to detect these effects.
吸入皮质激素的患者患者可能也暴露于其他的皮质类固醇类，或者其他条件使他们易罹患副反应，使吸入皮质激素危险的分析的结果受到影响。同时，许多的研究没有计划研究皮肤和眼部的影响，或者是时间太短不能监测这些影响。
Nevertheless, ICS have been associated with an increased risk of skin thinning, bruising, cataracts and possibly glaucoma in adults, but not in children. The risks increase with advanced age, higher doses, and longer duration of use. In children, the risks of cataracts and glaucoma were negligible with ICS, whether a mouthpiece or a mask interface was used. Side effects like skin rash and conjunctivitis occurred at low frequencies similar to placebo or comparator drugs. We do not know whether exposed children will have increased risks from ICS later in life. Therefore, it is wise to avoid face and eye deposition when possible, and to use the minimally effective dose.
然而，吸入皮质激素和皮肤变菲薄的危险升高、易碰伤、白内障、还可能和成人青光眼相关，但是在儿童中不出现。随着年龄增加、高剂量、长时间持续使用，上述危险增加。在儿童，吸入皮质激素导致白内障的危险安和青光眼的危险是可以忽略的，无论是使用衔嘴还是使用大面积的面罩方式。副反应像皮疹，结膜炎发生率较低，类似于安慰剂或者对照用药。我们不知道儿童暴露是否在以后的岁月中会增加吸入皮质激素的危险。因此，尽可能避免面部和眼睛的药物蓄积和使用最小有效剂量是明智的。
PMID: 17411401 [PubMed - in process]
编译后：545字
最新的研究认为临床气溶胶吸入疗法对皮肤的和眼部有副作用。雾化器给药通过气道给药达到最大的临床利益和通过减低虽然不是消除全身性暴露最小的副反应。学者Geller认为雾化器用面罩释放药物的方式可能不注意地使药物沉积于脸部和眼部，提高这些药物的皮肤和眼部的副反应。曾经有暴露于使用气溶胶给支气管扩张剂时双侧瞳孔大小不等的病例报道，像这样对于吸入的的皮质激素是否引起皮肤和眼睛的问题对照于全身或者局部使用激素是更难回答的。吸入皮质激素的患者患者可能也暴露于其他的皮质类固醇类，或者其他条件使他们易罹患副反应，使吸入皮质激素危险的分析的结果受到影响。同时许多的研究没有计划研究皮肤和眼部的影响，或者是时间太短不能监测这些影响。然而，吸入皮质激素和升高皮肤变菲薄的危险、易碰伤、白内障、还可能和成人青光眼相关，但是在儿童中不出现。随着年龄增加、高剂量、长时间持续使用，上述危险增加。在儿童，无论是使用衔嘴还是使用大面积的面罩方式，吸入皮质激素导致白内障的危险安和青光眼的危险是可以忽略的。而副反应像皮疹，结膜炎发生率较低，类似于安慰剂或者对照用药。但是我们尚不知道儿童的这种暴露方式是否在以后的岁月中会增加上述危险。因此，尽可能避免面部和眼睛的药物蓄积和使用最小有效剂量是明智的选择。该观点发表在最新的《气溶胶医学杂志》上。
