Potential adverse effects of the inhaled corticosteroids

Kelly, H. William; Nelson, Harold S.

doi:10.1016/s0091-6749(03)01870-0

Cited by 152 publications

(61 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In light of the widely publicised concerns about the potential harmful effects of high dose ICS in children, the BTS guidelines were updated in 2003 and lower doses of ICS recommended 36 37. The reduction in the proportion of children prescribed high and unlicensed dose ICS observed in this study was similar to that reported by Turner et al 38.…”

Section: Discussionsupporting

confidence: 80%

Changes in primary care prescribing patterns for paediatric asthma: a prescribing database analysis

Elkout

Helms²,

Simpson³

et al. 2011

Arch Dis Child

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 80%

Changes in primary care prescribing patterns for paediatric asthma: a prescribing database analysis

Elkout

Helms²,

Simpson³

et al. 2011

Arch Dis Child

View full text Add to dashboard Cite

show abstract

“…Although, we found no patients with symptomatic adrenal insufficiency or Cushing’s syndrome related to ICS use, previous reports of decreased adrenal function [4,6,7,8,9,10,11,12,13] and severe adrenal crisis [3,14,15,16] have highlighted the importance of detecting adrenal suppression, thereby making it possible to prevent side effects.…”

Section: Discussioncontrasting

confidence: 65%

“…However, these findings cannot in themselves account for FP being twice as efficient as BDP in terms of pulmonary function, and having twice as many systemic effects. This doubling of efficiency has been demonstrated in vivo [7, 13, 33], reviewed in [17,18] and is due to the pharmakinetics of ICS. The BUD/BDP conversion is taken into account by pharmaceutical companies, which indicate commercially labelled doses 25% higher than the real content of the product.…”

Section: Discussionmentioning

confidence: 89%

“…However, the short plasma half-lives of these molecules (about 4–5 h for BUD and 3 h for B-17-MP), limit their systemic activities [28,29]. The FP molecule is retained for prolonged periods in the lung due to its lipophilicity [13]. This lung retention results in slow systemic absorption via the pulmonary route and a systemic availability of 13% for FP-DPI and 21% for FP-MDI [28].…”

Section: Discussionmentioning

confidence: 99%

“…The systemic effects of ICS can be measured by testing adrenal function. In previous studies,25–35% of children treated with ICS displayed measurable decreases in adrenal function [4,6,7,8,9,10,11,12,13]. These biochemical deficiencies were long thought not to be associated with clinical features.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of the Low-Dose Corticotropin Stimulation Test for the Monitoring of Children with Asthma Treated with Inhaled Corticosteroids

Demay

Magny²,

Idres³

et al. 2006

Horm Res Paediatr

View full text Add to dashboard Cite

Objective: Subnormal hypothalamic-pituitary-adrenal (HPA) function and rare cases of adrenal crisis have been reported in asthmatic children treated with inhaled corticosteroids. We investigated subnormal HPA activity and followed up affected patients until recovery of normal HPA functions. Study Design: 100 children with persistent asthma underwent low-dose corticotropin testing, with the administration of 1 µg of 1–24 ACTH intravenously. Treatments were beclomethasone dipropionate as a metered-dose inhaler, n = 14, budesonide as a dry-powder inhaler, n = 16, fluticasone propionate as a metered-dose inhaler n = 31 or a dry-powder inhaler n = 39. The mean commercially labelled dose was 520 ± 29 µg/day (mean ± SEM, range: 160–1,000) and the equipotent dose (which compares the efficiency of these drugs for treating asthma and their responsibility for systemic effects) was 890 ± 55 µg/day (range: 200–2,000). Results: The mean stimulated cortisol level ± SEM (and range) of the patient was 482 ± 12 (148–801), and that of 40 age-matched controls was 580 ± 12.5 (439–726), (SD = 79). The result was subnormal (more than 2 SD below the mean of the controls) in28 of the 100 patients. One–four stepwise decreases of 10–100% in the daily equipotent doses received by the patients with abnormal low-dose corticotropin testing results led to normal results in subsequent low-dose corticotropin testing in 27 retested patients. The mean time interval between two tests was 5 months (range: 2–6 months) and the mean period required for normalization of the test was 13 months (range: 2–21). Only one case of asthma exacerbation and no adrenal crisis were observed over these periods. Conclusions: Decreasing daily equipotent doses led to recovery of normal HPA function without asthma exacerbation. Thus, a revision of the doses of inhaled corticosteroids used in asthmatic children with a progressive decrease to the consensus-recommended doses should decrease the systemic effects of inhaled corticosteroids, while minimizing the risk of asthma exacerbation.

show abstract