Corticosteroids are known to cause manic episodes, insomnia, and other CNS symptoms in many. This article concerns those who are using corticosteroids inhalers for asthma. Is it that helpful for asthma? There have been several articles warning about the dangers of beta2-agonists (LABAs) with corticosteroids. Later found to be of no benefits, (harmful), no longer advised for treating asthma. http://www.medicalnewstoday.com/articles/132495.php

Montelukast used to treat asthma has been linked to severe CNS reactions, including suicide ideation and self harm. http://www.leaderpost.com/news/Asthma+drug+linked+suicide+attempts+thoughts+self+harm/1768232/story.html

The article below, concerns inhaled corticosteroid and Diabetes Mellitus.

Inhaled Corticosteroid Use May Increase Risk for Diabetes Mellitus
Laurie Barclay, MD

December 15, 2010 — Inhaled corticosteroid use may increase the risk for diabetes mellitus, according to the results of a study reported in the November issue of the American Journal of Medicine.

"High doses of inhaled corticosteroids commonly used in patients with [chronic obstructive pulmonary disease (COPD)] are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin," lead author Samy Suissa, PhD, from the Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital in Montreal, Quebec, Canada, and the Department of Epidemiology and Biostatistics and Department of Medicine, McGill University, said in a news release. "Therefore, patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia and treatment with high doses of inhaled corticosteroids [should be] limited to situations where the benefit is clear."

The study authors note that although inhaled corticosteroids are recommended only for patients with the most severe COPD, current practice is that they are prescribed to more than 70% of all patients with COPD, including those with less severe disease. Because the prevalence of COPD and diabetes both increase with age, it is important to examine any possible interaction between inhaled corticosteroid use and worsened glycemic control.

Using the Quebec health insurance databases, the investigators identified a new-user cohort of patients treated from 1990 through 2005 for respiratory disease. Follow-up was through 2007, until diabetes onset, or until diabetes progression in the subcohort treated with oral hypoglycemics. To estimate the rate ratios of diabetes onset and progression associated with current use of inhaled corticosteroids, the investigators used a nested case-control analysis, with adjustment for age, sex, respiratory disease severity, and comorbid conditions.

Of 388,584 patients in the study cohort, 30,167 developed incident diabetes during 5.5 years of follow-up (incidence rate, 14.2/1000/year), and 2099 patients subsequently progressed from oral hypoglycemic therapy to insulin treatment (incidence rate, 19.8/1000/year).

Participants with current use of inhaled corticosteroids had a 34% increase in the rate of diabetes (rate ratio [RR], 1.34; 95% confidence interval [CI], 1.29 - 1.39) and in the rate of diabetes progression (RR, 1.34; 95% CI, 1.17 - 1.53).

The highest inhaled corticosteroid doses, equivalent to at least 1000 μg/day fluticasone, were associated with the greatest risk increases (RR for rate of diabetes, 1.64; 95% CI, 1.52 - 1.76; RR for diabetes progression, 1.54; 95% CI, 1.18 - 2.02).

Limitations of this study include possible residual confounding and the possible underestimation of incidence of diabetes.

"In patients with respiratory disease, inhaled corticosteroid use is associated with modest increases in the risks of diabetes onset and diabetes progression," the study authors write. "The risks are more pronounced at the higher doses currently prescribed in the treatment of [COPD]."

This research was supported by grants from the Canadian Institutes of Health Research, Boehringer-Ingelheim GmbH, and the Canadian Foundation for Innovation. Some of the study authors report various financial relationships with AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Pfizer, Merck Frosst Canada, Novartis, and/or Nycomed.

Am J Med. 2010;123:1001-1006. Abstract