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document
Skin manifestations of inhaled corticosteroids in COPD patients : results from Lung Health Study II . OBJECTIVE To define the relationship between skin bruising ( as well as other cutaneous manifestations ) and inhaled corticosteroid ( ICS ) therapy vs placebo in subjects with COPD who were participating in a clinical trial . To explore the relationship between easy skin bruising and other systemic effects of ICS therapy , including adrenal suppression and loss of bone mineral density ( BMD ) . DESIGN Double-blind , randomized , placebo-controlled clinical trial of triamcinolone acetonide ( 1200 microg daily ) vs placebo in participants with mild-to-moderate COPD . SETTING Lung Health Study II , a clinical trial to assess the effect of ICS compared to placebo in 1,116 participants in 10 centers over > 3.5 to 4.5 years . PARTICIPANTS A total of 1,116 smokers or recent ex-smokers with mild-to-moderate COPD ( age range , 40 to 69 years ; mean age , 56.3 years ; 37.2 % female ) . MEASUREMENTS AND RESULTS Every 6 months , a structured questionnaire was administered to elicit reports of any bruising and/or skin rashes , slow healing of cuts or sores , or other skin changes . Compliance with inhaler use was assessed by canister weighing . A significantly higher proportion of ICS than placebo participants who complied with using their inhaler reported easy bruising ( 11.2 % vs 3.5 % , respectively ) and the slow healing of skin cuts or sores ( 2.4 % vs 0.5 % , respectively ) . Older men in the ICS group with good inhaler compliance appeared to be at the greatest risk of bruising . In those participants undergoing serial measurements of adrenal function and BMD , no association was noted between skin bruising and either the suppression of adrenal function or the loss of BMD as systemic complications of ICS use . CONCLUSION These findings indicate that moderate-to-high doses of ICSs result in an increased incidence of easy bruising and impairment in skin healing in middle-aged to elderly persons with COPD . No association was noted between skin bruising and other markers of systemic toxicity from the use of ICSs .
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Intervention_Pharmacological
corticosteroids
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Intervention_Pharmacological
corticosteroid ( ICS )
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Intervention_Pharmacological
triamcinolone acetonide
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Intervention_Control
placebo
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Intervention_Pharmacological
ICS
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Intervention_Pharmacological
ICS
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Intervention_Pharmacological
ICS
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Outcome_Physical
Skin manifestations of inhaled corticosteroids
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Outcome_Adverse-effects
skin bruising
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Outcome_Adverse-effects
cutaneous manifestations
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Outcome_Adverse-effects
adrenal suppression
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Outcome_Physical
and
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Outcome_Adverse-effects
loss of bone mineral density ( BMD
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Outcome_Adverse-effects
bruising and/or skin rashes , slow healing of cuts or sores
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Outcome_Adverse-effects
skin changes
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Outcome_Adverse-effects
easy bruising
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Outcome_Adverse-effects
slow healing of skin cuts or sores
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Outcome_Adverse-effects
risk of bruising
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Outcome_Adverse-effects
skin bruising
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Outcome_Adverse-effects
suppression of adrenal function
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Outcome_Adverse-effects
loss of BMD
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Outcome_Adverse-effects
easy bruising
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Outcome_Adverse-effects
impairment in skin healing
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Outcome_Adverse-effects
skin bruising
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Outcome_Adverse-effects
systemic toxicity
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Participant_Condition
COPD patients :
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Participant_Condition
subjects with COPD