Introduction
Glucocorticoids are commonly used for their anti-inflammatory and
immunomodulatory properties in the treatment of a wide range of
inflammatory, immunological, allergic and malignant diseases. A recent
population study from Denmark found that the annual prevalence of
systemic (oral and injectable) glucocorticoid use was
~3%, increasing to 6.7-7.7% in people 60-79 years of
age and to 9.7-11% in those ≥80 years of age [1]. In 2018 in
England, 8 million prescriptions for systemic glucocorticoids, 21
million prescriptions for inhaled glucocorticoids and 12 million
prescriptions for topical glucocorticoids were dispensed in the
community [2]. Glucocorticoids bind to glucocorticoid receptors,
which are expressed in almost every cell in the body and have
pleiotropic effects on multiple signalling pathways [3]. This makes
them highly effective anti-inflammatory drugs, but also causes diverse
serious adverse effects that limit their use.