Expert Answers: Eye Problems and COPD

Quite often, here at COPD.net, community members ask questions coming from their personal experience with COPD. It can be helpful to have our experts weigh in, in response to these types of questions. So, we asked our experts:

What can you tell me about eye problems from steroid inhalers and using oxygen? What could help us?

Response from John
I was aware of the link between systemic steroids and eye issues, although had never thought of inhaled steroids being linked to them. The first site I found (www.asthma.partners.org) discussing this issue noted a theory that long term use of inhaled steroids may cause a small amount of inhaled steroids to get into your bloodstream through your lungs. This means that this will happen even if you rinse your mouth out well after each puff. Over time, this may result in glaucoma and cataracts. The site referred to studies showing no increased risk for developing glaucoma when taking lower doses of inhaled steroids, although a 40% greater risk when taking higher doses.

Another study showed an increased risk for developing cataracts even when taking low doses of inhaled steroids, although the risk increases at higher dosing. The site makes reference to a common notion among asthma experts, that the short term risks of not taking asthma medicine is far greater than any potential long term eye issues. They recommend regular eye exams after the age of 65. Personally, I take Advair every day, and sometimes require higher doses, even systemic steroids occasionally. To me, it is well worth any potential future risks. Of course, this is another reason to take the lowest dose possible. As far as supplemental oxygen used to treat COPD causing eye issues, I am not aware of any such a link, although perhaps my fellow COPD experts can shed more light on this subject. Either way, as with steroids, the short term benefits far outweigh any future risks.

Response from Leon
Oxygen therapy, sometimes referred to as supplemental oxygen therapy, is a form of treatment often prescribed for patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD). We are all aware that COPD can cause damage to the lungs. The lung damage compromises the absorption of oxygen by the lung and consequentially, getting into the blood for distribution to the body. Oxygen therapy helps to deliver an extra supply of oxygen into the body which then may improve symptoms of COPD. Oxygen therapy is part of the treatment plan for many patients with COPD although not all COPD patients need oxygen therapy.1-5

The use of inhaled corticosteroids (ICS), particularly in combination with a long-acting beta-agonist (LABA), is an accepted mainstay in the management of patients with stable COPD. However, some people have become very apprehensive about having to take “steroids” because of concerns about the side effects associated with their use. The question as to whether there is a connection between the use of ICS and the risk of developing glaucoma, can be a genuine concern for people using them. Many of the well known side effects of long term steroid usage are associated with the use of systemic steroids over long periods of time. Most of these potentially harmful side effects are avoided by using the medication in an aerosolized form via inhalation. Inhaled corticosteroids are delivered directly to where they are needed, namely the inflamed bronchial tubes, and not to the remainder of the body, as with systemic steroids. In general, at the usual doses (400-800 micrograms/day), the amount of steroid passing into the bloodstream is minimal, especially when a spacer is used and mouth rinsing is performed after each use. At standard doses one does not develop any side effects in the eyes (or elsewhere). Another recommendation for proper administration of ICS is to close the eyes prior to actuation so as to protect them from errant aerosol particles (again, minimized when a spacer is utilized).1-5

Before being tempted to give up your inhaled steroid medicine for fear of complications in your eyes (or elsewhere), remember that for persons taking any less than the largest doses of ICS, there is no evidence that the inhaled steroids are harmful to the eyes. And remember, too, that the chance of having an exacerbation of your COPD severe enough to require hospitalization, is reduced significantly by the use of inhaled steroids. Used wisely, and in the lowest doses that are effective, these medicines, in combination with one of the long acting beta agonists, are still the best long-term treatment. For those who are still concerned, it is best discussed with your prescribing physician or ophthalmologist.1-5

Response from Lyn
There have been a couple of recent studies done on inhaled steroid use contributing to cataracts or glaucoma. First, it is important to note that using inhaled steroids is not the same as taking oral steroids. If a person is taking an inhaled steroid, obviously they want to make sure they get all the medication into their mouth and down into their airways. Since a person is usually taking it because they are treating inflammation of the airways, it’s imperative that the mediation be delivered to those airways. For the most part, this limits any potentially harmful, general side effects that are common when taking oral steroids. That’s not to say that some of the medication isn’t absorbed into the bloodstream, particularly if a person is taking high doses. So, to be safe, more and more physicians are recommending that a person over 65 that takes high doses of inhaled steroids sees an ophthalmologist to have a glaucoma test done. The ophthalmologist will probably get a baseline reading and then suggest you come back periodically to be tested again.

In premature infants, a high concentration of oxygen is a factor in causing a disorder known as retinopathy of prematurity (ROP). After about 1 month old, this isn’t something we worry about.

In general, for a person requiring oxygen the benefits far outweigh the risks. That is a very important fact to remember. In an adult on supplemental oxygen, the goal is always to use the lowest possible amount of oxygen to reach adequate oxygenation of the tissues. This is why a doctor may periodically order a blood sample (ABG) to monitor oxygen level in the tissues. The doctor has not indiscriminately picked a liter flow of oxygen but rather it’s based on tests such as pulse oximetry and ABG’s. In fact, you may have a different flow rate you use when you’re active as opposed to when you’re resting or relaxing. The point is the flow rate prescribed by your physician is very specific to your particular needs and condition. Therefore, unless you have real cause for concern that you’re on higher liter flows than you need to be, there isn’t reason to worry.

How about you? What are your thoughts on what you just read? Share in the comments below!

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