© 2003 BMJ Publishing Group & Royal College of Paediatrics and Child Health
LETTER
Moderately high doses still need to be considered for very young children
Respiratory Unit, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK; dominic.cochran@sgh.scot.nhs.uk
Keywords: adrenal crisis; high-dose fluticasone; inhaled corticosteroids
| The first 150 words of the full text of this article appear below. |
In relation to the question of adrenal suppression when using higher doses of inhaled corticosteroid, I believe there is an aspect of dose selection which has not been mentioned by previous authors.
There are limited data on the question of intra-pulmonary drug deposition in children under 3 years but the studies that have been published seem to indicate that around 1–2% of the drug released into the spacer reaches the airways,1 compared to 15–17% in an adult using the same device. Based on this figure, it seems reasonable to prescribe similar doses to very young children and adults alike.
I note that none of the cases of adrenal impairment have been reported in children under 3 years of age; most of them are significantly older. This could be partly because higher doses are not being used in this age group, but might also be confirmation that a smaller fraction of
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