Page 17 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Adverse-effects related to the chronic use of systemic glucocorticoids
Systemic exposure to glucocorticoids is associated with a long list of undesirable adverse-effects [47;51-55], including osteoporosis [52;56], psychiatric disorders [57;58], susceptibility to infections [59], cardiovascular disease [60;61], hyperglycemia [62], diabetes mellitus and ophthalmologic events [63] (Figure 2). Most of these adverse-effects are related to the cumulative dose of systemic glucocorticoids, which means that not only the daily dose [47;52;56], but also the duration [64] and the frequency [65] of steroid consumption increases the risk of associated morbidities.
Figure 2: Major adverse events associated with glucocorticoid therapy
Legend to figure 2: Adverse effects associated to systemic glucocorticoids (adapted from www.uptodate. com/contents/major-side-effects-of-systemic-glucocorticoids, last accessed October 2018)
An important and sometimes underestimated effect of glucocorticoids is the alteration in hemostasis caused by the increase of the coagulant and decrease in fibrinolytic factors [66], since this may lead to life-threatening thrombotic events such as pulmonary embolism [67].
Psychiatric problems can emerge or worsen due to systemic glucocorticoid treatment [68]. Mood alterations, euphoria, depression, and suicide attempts
General introduction and aims of the thesis
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