Decreased incidence of glaucoma in children with asthma using inhaled corticosteroid: a cohort study
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Ling-Sai Chang1,2,3,*, Hui-Ching Lee4,*, Yuh-Chyn Tsai4,*, Lien-Shi Shen4, Ching-Ling Li4, Shih-Feng Liu4,5 and Ho-Chang Kuo1,3
1Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Taiwan, China
2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan, China
3Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, China
4Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Taiwan, China
5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, China
*These author have contributed equally to this work
Shih-Feng Liu, email: [email protected]yahoo.com.tw
Keywords: asthma; child; glaucoma; inhaled corticosteroid; taiwan national health
Received: June 13, 2017 Accepted: October 04, 2017 Published: November 01, 2017
Among the anti-inflammatory medications used for treating asthma, corticosteroids are the most effective. The effects of orally administered corticosteroids on intraocular pressure and lens opacity have been well defined, but the influence of inhaled corticosteroids (ICS) on children has yet to be clearly explained. Therefore, we used a nationwide cohort database to investigate glaucoma in childhood asthma patients using ICS. We analyzed a dataset of 1,000,000 randomly sampled individuals from Taiwan’s 2000 National Health Insurance Research Database. The study cohort included 5,380 patients who were first diagnosed with asthma (ICD9: 493.X) diagnosis when they were six years old or younger. All subjects were followed through December 2011. We applied Cox’s proportional hazard model to determine whether ICS use has a correlation with glaucoma. Of the 5,380 patients enrolled in this study, we identified 1,232 patients who had used ICS and 4,148 patients who had no history of ICS administration throughout the follow-up period. The prevalence of glaucoma was significantly lower in patients using ICS, with a 0.52-fold decreased risk of developing glaucoma in comparison to the control group [adjusted hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.28~0.96]. Among the evaluated comorbidities, cataract was positively associated with glaucoma in asthma children (adjusted HR 8.22; 95% CI = 2.59~26.12). This study provides not only the first but also strong evidence that the glaucoma incidence in the ICS group is lower than that in the non-ICS group in children with asthma. Further consultation with an ophthalmologist regarding the high-risk group of asthma children with cataracts is necessary.
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