Easy bruising as a side-effect of inhaled corticosteroids

Abstract

We wished to determine the prevalence of easy bruising in patients taking inhaled corticosteroids (ICS) compared with those who do not. Differences in age, dosage and duration of use of ICS between patients who bruised and those who did not were also investigated. Confidential questionnaire surveys were conducted over a 6 month study period amongst patients attending a respiratory out-patient clinic and taking regular ICS, and a control group of patients attending non-respiratory clinics and not taking any form of corticosteroids. Patients with bleeding disorders or taking oral steroids, non-steroidal anti-inflammatory drugs or anticoagulants were excluded from the study. Questionnaires from 202 respiratory patients using ICS (group A) were compared with 204 non-ICS patients (Group B) of similar age and sex distribution. Significantly more patients in Group A reported easy bruising than in group B (47 vs 22%, relative risk 2.18, 95% confidence interval (95% CI) 1.62-2.94), and it was the commonest reported symptom. In Group A, the patients that reported easy bruising tended to be older (61 vs 52 yrs), on higher daily dosages (1,388 vs 1,067 μg) and had been taking inhaled corticosteroids for longer (55 vs 43 months) than non-bruisers. Overall, females reported easy bruising more frequently than males in both groups. However, comparing Group A with Group B, males taking ICS had a higher relative risk for bruising than females (males, relative risk 5.80, 95% CI 2.38-14.13; females, relative risk 1.80, 95% CI 1.32-2.44). The prevalence of easy bruising increased significantly with increasing dosage and increasing duration of use of ICS. Also, the prevalence of easy bruising increased significantly with age in Group A but not in Group B. However, this effect of age was not significant in patients taking <1,000 μg·day-1. There was no difference in the proportion of bruisers and non-bruisers who had previously been treated with continuous oral steroids, nor in the number of courses of oral corticosteroids taken over the previous year. Easy bruising should be recognized as a frequent side-effect of inhaled corticosteroids, which increases in prevalence with increasing age, dosage and duration of use.