Poster sessionsThorax 2012;67(Suppl 2):A1-A204 A67 Introduction Inhaled corticosteroids (ICS) are the mainstay of treatment in asthma. Whilst they are felt to be safe in low doses, a number of case studies have demonstrated adrenal suppression in higher doses, particularly in paediatric patients. The relative frequency of this is largely unknown, but we believe it may be significantly underrecognised in patients with difficult to treat asthma. As part of our difficult asthma protocol we measure random cortisol levels and proceeded to further investigations if this was abnormal or the patient presented with symptoms of adrenal insufficiency. Methods Patients were assessed through the Difficult Asthma Service in Leeds which is a tertiary referral centre for West Yorkshire. Patients who had non-specific symptoms out of keeping with asthma, either had a random serum cortisol taken or had a short synacthen test. Patients were classified as: adrenal insufficient with a cortisol less than 50nmol/L or a positive short synacthen test, and adrenal sufficient with a random cortisol greater than 120nmol/L or a negative short synacthen test. A further group was defined as suboptimal if their random cortisol was between 50-120nmol/L Data were also collected on ICS dose and type, and atopic status. Results Ninety-two random cortisol samples have been taken to date. Of these, 8 patients who were not on oral corticosteroids were found to have adrenal insufficiency (8.7%). Seven patients had a random cortisol less than 50nmol/L and one had a positive short synacthen test. Of the patients with adrenal insufficiency six patients were on a combination inhaler including fluticasone, and all received a daily BDP dose over 1000mcg. None of the patients with adrenal insufficiency demonstrated evidence of atopy, except one patient with co-existent ABPA receiving itraconazole therapy. Conclusions We have identified a significant number of patients with evidence of adrenal insufficiency, with the majority identified by a random cortisol. This is likely to be under-estimated, as the 92
P9to identify desirable attributes of an inhaler.(2,3) "Ease of use" is an important characteristic but is often determined after instructed training. Whilst the importance of initial and repeat correct inhaler technique training cannot be overlooked, a dry powder inhaler (DPI) device that is intuitively easy to use may be more beneficial for those patients with poor technique recall or with barriers to access adequate training. An intuitively easy to use inhaler such as the Sandoz Forspiro™ device may facilitate correct patient handling. A 28 day study to assess the intuitive ease of use of the Forspiro device was conducted in 24 Accuhaler® users (≥ 1 year use), aged 20-86 years (mean age = 53.8). Participants were separated into 2 groups of 12 and received either limited written instructions about the use of the device (Uninstructed) or were given fully illustrated instructions for use (Instructed). See table 1. The correlation of the ease of use assessmen...
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