The FDA approved a supplement to new drug application NDA022315, a dexamethasone intravitreal implant, filed by AbbVie. This is an ophthalmic product and it changes nothing in respiratory prescribing.
It is worth one paragraph for a different reason. Long-term systemic corticosteroid exposure is a routine feature of severe asthma, chronic obstructive pulmonary disease with frequent exacerbations, interstitial lung disease and sarcoidosis, and it carries well-established ocular consequences: posterior subcapsular cataract and raised intraocular pressure, both of which are asymptomatic until they are not. Steroid-induced ocular hypertension can progress to glaucoma without the patient noticing anything.
In a clinic organised around lung function, nobody owns the eye. A patient on maintenance prednisolone, or one taking repeated rescue courses each year, should have their cumulative exposure recorded and an eye examination arranged - and that referral is one a respiratory physician has to initiate, because no other clinician in the pathway will.
- This approval is for an intravitreal implant and has no respiratory application.
- Record cumulative systemic corticosteroid exposure, including rescue courses, not just maintenance dose.
- Arrange eye examination for patients on long-term or frequently repeated systemic corticosteroids.
- Posterior subcapsular cataract and raised intraocular pressure are both silent until advanced.
- Steroid-sparing options in severe asthma exist partly to avoid exactly these harms.
Why it matters
The ocular harms of long-term systemic corticosteroids are silent, and a respiratory clinic is the only place they will be noticed in time.
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