{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T14:22:39Z","timestamp":1782570159355,"version":"3.54.5"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["NRF-2022R1C1C1010045"],"award-info":[{"award-number":["NRF-2022R1C1C1010045"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Soonchunhyang University Research Fund"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-024-78298-2","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T01:47:19Z","timestamp":1732153639000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Inhaled corticosteroid increased the risk of adrenal insufficiency in patients with chronic airway diseases: a nationwide population-based study"],"prefix":"10.1038","volume":"14","author":[{"given":"Hyewon","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Young","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"78298_CR1","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2174\/1874306401509010037","volume":"9","author":"J Minov","year":"2015","unstructured":"Minov, J. & Stoleski, S. Chronic obstructive airways diseases: Where are we now?. Open Respir Med J 9, 37\u201338 (2015).","journal-title":"Open Respir Med J"},{"key":"78298_CR2","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/s12889-024-17686-9","volume":"24","author":"N Al Wachami","year":"2024","unstructured":"Al Wachami, N. et al. Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): A systematic review and meta-analysis. BMC Public Health 24, 297 (2024).","journal-title":"BMC Public Health"},{"key":"78298_CR3","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1111\/resp.14349","volume":"28","author":"HY Li","year":"2023","unstructured":"Li, H. Y. et al. Global, regional and national burden of chronic obstructive pulmonary disease over a 30-year period: Estimates from the 1990 to 2019 Global Burden of Disease Study. Respirology 28, 29\u201336 (2023).","journal-title":"Respirology"},{"key":"78298_CR4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.46598","volume":"6","author":"E Boers","year":"2023","unstructured":"Boers, E. et al. Global burden of chronic obstructive pulmonary disease through 2050. JAMA Netw Open 6, e2346598 (2023).","journal-title":"JAMA Netw Open"},{"key":"78298_CR5","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1186\/s12931-023-02475-6","volume":"24","author":"Z Wang","year":"2023","unstructured":"Wang, Z. et al. Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Respir Res 24, 169 (2023).","journal-title":"Respir Res"},{"key":"78298_CR6","first-page":"852","volume":"52","author":"GC Phua","year":"2007","unstructured":"Phua, G. C. & Macintyre, N. R. Inhaled corticosteroids in obstructive airway disease. Respir Care 52, 852\u2013858 (2007).","journal-title":"Respir Care"},{"key":"78298_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2022.108960","volume":"236","author":"W Shang","year":"2022","unstructured":"Shang, W., Wang, G., Wang, Y. & Han, D. The safety of long-term use of inhaled corticosteroids in patients with asthma: A systematic review and meta-analysis. Clin Immunol 236, 108960 (2022).","journal-title":"Clin Immunol"},{"key":"78298_CR8","doi-asserted-by":"crossref","unstructured":"Miravitlles, M. et al. Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD. Eur Respir Rev 30 (2021).","DOI":"10.1183\/16000617.0075-2021"},{"key":"78298_CR9","doi-asserted-by":"publisher","first-page":"59","DOI":"10.2174\/1874306401408010059","volume":"8","author":"D Pandya","year":"2014","unstructured":"Pandya, D., Puttanna, A. & Balagopal, V. Systemic effects of inhaled corticosteroids: An overview. Open Respir Med J 8, 59\u201365 (2014).","journal-title":"Open Respir Med J"},{"key":"78298_CR10","doi-asserted-by":"crossref","unstructured":"Patel, R., Naqvi, S. A., Griffiths, C. & Bloom, C. I. Systemic adverse effects from inhaled corticosteroid use in asthma: A systematic review. BMJ Open Respir Res 7 (2020).","DOI":"10.1136\/bmjresp-2020-000756"},{"key":"78298_CR11","doi-asserted-by":"publisher","first-page":"93","DOI":"10.2174\/1874306401408010093","volume":"8","author":"V Sannarangappa","year":"2014","unstructured":"Sannarangappa, V. & Jalleh, R. Inhaled corticosteroids and secondary adrenal insufficiency. Open Respir Med J 8, 93\u2013100 (2014).","journal-title":"Open Respir Med J"},{"key":"78298_CR12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1136\/thx.2005.052456","volume":"61","author":"KJ Mortimer","year":"2006","unstructured":"Mortimer, K. J. et al. Oral and inhaled corticosteroids and adrenal insufficiency: A case-control study. Thorax 61, 405\u2013408 (2006).","journal-title":"Thorax"},{"key":"78298_CR13","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1183\/09031936.00080912","volume":"42","author":"F Lapi","year":"2013","unstructured":"Lapi, F., Kezouh, A., Suissa, S. & Ernst, P. The use of inhaled corticosteroids and the risk of adrenal insufficiency. Eur Respir J 42, 79\u201386 (2013).","journal-title":"Eur Respir J"},{"key":"78298_CR14","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1210\/jc.2015-1218","volume":"100","author":"LH Broersen","year":"2015","unstructured":"Broersen, L. H., Pereira, A. M., J\u00f8rgensen, J. O. & Dekkers, O. M. Adrenal insufficiency in corticosteroids use: Systematic review and meta-analysis. J Clin Endocrinol Metab 100, 2171\u20132180 (2015).","journal-title":"J Clin Endocrinol Metab"},{"key":"78298_CR15","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1136\/adc.87.6.457","volume":"87","author":"GR Todd","year":"2002","unstructured":"Todd, G. R. et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child 87, 457\u2013461 (2002).","journal-title":"Arch Dis Child"},{"key":"78298_CR16","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/S1081-1206(10)61117-9","volume":"94","author":"BJ Lipworth","year":"2005","unstructured":"Lipworth, B. J. et al. Effect of ciclesonide and fluticasone on hypothalamic-pituitary-adrenal axis function in adults with mild-to-moderate persistent asthma. Ann Allergy Asthma Immunol 94, 465\u2013472 (2005).","journal-title":"Ann Allergy Asthma Immunol"},{"key":"78298_CR17","doi-asserted-by":"publisher","first-page":"848","DOI":"10.3109\/02770903.2011.604883","volume":"48","author":"DP Skoner","year":"2011","unstructured":"Skoner, D. P. et al. Effects of inhaled mometasone furoate on growth velocity and adrenal function: A placebo-controlled trial in children 4\u20139 years old with mild persistent asthma. J Asthma 48, 848\u2013859 (2011).","journal-title":"J Asthma"},{"key":"78298_CR18","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2500\/aap.2016.37.3912","volume":"37","author":"ML Kowalski","year":"2016","unstructured":"Kowalski, M. L., Wojciechowski, P., Dziewonska, M. & Rys, P. Adrenal suppression by inhaled corticosteroids in patients with asthma: A systematic review and quantitative analysis. Allergy Asthma Proc 37, 9\u201317 (2016).","journal-title":"Allergy Asthma Proc"},{"key":"78298_CR19","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1378\/chest.124.1.57","volume":"124","author":"MS Eichenhorn","year":"2003","unstructured":"Eichenhorn, M. S. et al. Lack of long-term adverse adrenal effects from inhaled triamcinolone: Lung Health Study II. Chest 124, 57\u201362 (2003).","journal-title":"Chest"},{"key":"78298_CR20","doi-asserted-by":"publisher","first-page":"140","DOI":"10.4103\/1817-1737.98846","volume":"7","author":"A Fahim","year":"2012","unstructured":"Fahim, A., Faruqi, S., Wright, C. E., Kastelik, J. A. & Morice, A. H. Comparison of the effect of high-dose inhaled budesonide and fluticasone on adrenal function in patients with severe chronic obstructive pulmonary disease. Ann Thorac Med 7, 140\u2013144 (2012).","journal-title":"Ann Thorac Med"},{"key":"78298_CR21","volume":"46","author":"J Lee","year":"2017","unstructured":"Lee, J., Lee, J. S., Park, S. H., Shin, S. A. & Kim, K. Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC). South Korea. Int J Epidemiol 46, e15 (2017).","journal-title":"South Korea. Int J Epidemiol"},{"key":"78298_CR22","unstructured":"Publication, N. I. o. H. National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute. Expert panel report 2: Guidelines for the diagnosis and management of asthma Available from: http:\/\/www.nhlbi.nih.gov\/guidelines\/asthma\/asthgdln.htm (accessed Apr 2024). 97\u20134051 (1997)."},{"key":"78298_CR23","unstructured":"Boulet, L. Canadian asthma consensus group. Canadian asthma consensus report, 1999. CMAJ 30 161, S1-S61 (1999)."},{"key":"78298_CR24","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1164\/rccm.200611-1630OC","volume":"176","author":"P Ernst","year":"2007","unstructured":"Ernst, P., Gonzalez, A. V., Brassard, P. & Suissa, S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 176, 162\u2013166 (2007).","journal-title":"Am J Respir Crit Care Med"},{"key":"78298_CR25","doi-asserted-by":"publisher","first-page":"18973","DOI":"10.1038\/s41598-020-74854-8","volume":"10","author":"J Shin","year":"2020","unstructured":"Shin, J., Yoon, H. Y., Lee, Y. M., Ha, E. & Lee, J. H. Inhaled corticosteroids in COPD and the risk for coronary heart disease: A nationwide cohort study. Sci Rep 10, 18973 (2020).","journal-title":"Sci Rep"},{"key":"78298_CR26","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","volume":"34","author":"PC Austin","year":"2015","unstructured":"Austin, P. C. & Stuart, E. A. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34, 3661\u20133679 (2015).","journal-title":"Stat Med"},{"key":"78298_CR27","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","volume":"46","author":"PC Austin","year":"2011","unstructured":"Austin, P. C. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46, 399\u2013424 (2011).","journal-title":"Multivariate Behav Res"},{"key":"78298_CR28","doi-asserted-by":"publisher","unstructured":"Yoon, E. C., Lee, H. & Yoon, H. Y. Inhaled corticosteroids and the risk of nontuberculous mycobacterial infection in chronic airway disease: A nationwide population-based study. Tuberc Respir Dis (Seoul); https:\/\/doi.org\/10.4046\/trd.2024.0038 (2024).","DOI":"10.4046\/trd.2024.0038"},{"key":"78298_CR29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003880","volume":"19","author":"SY Yu","year":"2022","unstructured":"Yu, S. Y. et al. Low-dose aspirin and incidence of lung carcinoma in patients with chronic obstructive pulmonary disease in Hong Kong: A cohort study. PLoS Med 19, e1003880 (2022).","journal-title":"PLoS Med"},{"key":"78298_CR30","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1093\/ckj\/sfab158","volume":"15","author":"NC Chesnaye","year":"2022","unstructured":"Chesnaye, N. C. et al. An introduction to inverse probability of treatment weighting in observational research. Clin Kidney J 15, 14\u201320 (2022).","journal-title":"Clin Kidney J"},{"key":"78298_CR31","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","volume":"28","author":"PC Austin","year":"2009","unstructured":"Austin, P. C. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28, 3083\u20133107 (2009).","journal-title":"Stat Med"},{"key":"78298_CR32","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1136\/thoraxjnl-2012-202872","volume":"68","author":"S Suissa","year":"2013","unstructured":"Suissa, S., Patenaude, V., Lapi, F. & Ernst, P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax 68, 1029\u20131036 (2013).","journal-title":"Thorax"},{"key":"78298_CR33","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1136\/ard.61.8.718","volume":"61","author":"F Buttgereit","year":"2002","unstructured":"Buttgereit, F. et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: Current questions and tentative answers in rheumatology. Ann Rheum Dis 61, 718\u2013722 (2002).","journal-title":"Ann Rheum Dis"},{"key":"78298_CR34","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1161\/01.STR.0000135225.80898.1c","volume":"35","author":"LB Goldstein","year":"2004","unstructured":"Goldstein, L. B., Samsa, G. P., Matchar, D. B. & Horner, R. D. Charlson Index comorbidity adjustment for ischemic stroke outcome studies. Stroke 35, 1941\u20131945 (2004).","journal-title":"Stroke"},{"key":"78298_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1365-2710.2008.00970.x","volume":"34","author":"AP Baptist","year":"2009","unstructured":"Baptist, A. P. & Reddy, R. C. Inhaled corticosteroids for asthma: Are they all the same?. J Clin Pharm Ther 34, 1\u201312 (2009).","journal-title":"J Clin Pharm Ther"},{"key":"78298_CR36","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1111\/bcp.12637","volume":"80","author":"PT Daley-Yates","year":"2015","unstructured":"Daley-Yates, P. T. Inhaled corticosteroids: Potency, dose equivalence and therapeutic index. Br J Clin Pharmacol 80, 372\u2013380 (2015).","journal-title":"Br J Clin Pharmacol"},{"key":"78298_CR37","unstructured":"Loscalzo, J. et al. in Harrison\u2019s Principles of Internal Medicine, 21e (McGraw-Hill Education, 2022)."},{"key":"78298_CR38","doi-asserted-by":"crossref","unstructured":"Pelewicz, K. & Mi\u015bkiewicz, P. Glucocorticoid Withdrawal-An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice. Diagnostics (Basel) 11 (2021).","DOI":"10.3390\/diagnostics11040728"},{"key":"78298_CR39","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.ejim.2013.05.014","volume":"24","author":"S Dinsen","year":"2013","unstructured":"Dinsen, S. et al. Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself. Eur J Intern Med 24, 714\u2013720 (2013).","journal-title":"Eur J Intern Med"},{"key":"78298_CR40","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1038\/s41591-022-01714-5","volume":"28","author":"P Kachroo","year":"2022","unstructured":"Kachroo, P. et al. Metabolomic profiling reveals extensive adrenal suppression due to inhaled corticosteroid therapy in asthma. Nat Med 28, 814\u2013822 (2022).","journal-title":"Nat Med"},{"key":"78298_CR41","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s13223-015-0075-z","volume":"11","author":"K Issa-El-Khoury","year":"2015","unstructured":"Issa-El-Khoury, K., Kim, H., Chan, E. S., Vander Leek, T. & Noya, F. CSACI position statement: Systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma. Allergy Asthma Clin Immunol 11, 9 (2015).","journal-title":"Allergy Asthma Clin Immunol"},{"key":"78298_CR42","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1710-1492-7-13","volume":"7","author":"A Ahmet","year":"2011","unstructured":"Ahmet, A., Kim, H. & Spier, S. Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol 7, 13 (2011).","journal-title":"Allergy Asthma Clin Immunol"},{"key":"78298_CR43","unstructured":"Asthma., G. I. f. Global Strategy for Asthma Management and Prevention, 2023. (GINA, 2022, 2023)."},{"key":"78298_CR44","doi-asserted-by":"crossref","unstructured":"Agusti, A. et al. Inhaled corticosteroids in COPD: Friend or foe? Eur Respir J 52 (2018).","DOI":"10.1183\/13993003.01219-2018"},{"key":"78298_CR45","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.ccm.2020.05.006","volume":"41","author":"T Mkorombindo","year":"2020","unstructured":"Mkorombindo, T. & Dransfield, M. T. Inhaled corticosteroids in chronic obstructive pulmonary disease: Benefits and risks. Clin Chest Med 41, 475\u2013484 (2020).","journal-title":"Clin Chest Med"},{"key":"78298_CR46","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1136\/archdischild-2016-311223","volume":"102","author":"EB Goldbloom","year":"2017","unstructured":"Goldbloom, E. B. et al. Symptomatic adrenal suppression among children in Canada. Arch Dis Child 102, 338\u2013339 (2017).","journal-title":"Arch Dis Child"},{"key":"78298_CR47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2466-8-1","volume":"8","author":"P Schuetz","year":"2008","unstructured":"Schuetz, P. et al. Effect of a 14-day course of systemic corticosteroids on the hypothalamic-pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 8, 1 (2008).","journal-title":"BMC Pulm Med"},{"key":"78298_CR48","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.1056\/NEJMra0804635","volume":"360","author":"SR Bornstein","year":"2009","unstructured":"Bornstein, S. R. Predisposing factors for adrenal insufficiency. New England Journal of Medicine 360, 2328\u20132339 (2009).","journal-title":"New England Journal of Medicine"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78298-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78298-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78298-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T02:10:16Z","timestamp":1732155016000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78298-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["78298"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-78298-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4591759\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,21]]},"assertion":[{"value":"17 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study protocol was approved by the Institutional Review Board of the Soonchunhyang University Seoul Hospital (2023-06-008), and the requirement for informed consent was waived due to the de-identified nature of the NHIS-NSC dataset.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"28831"}}