PERSPECTIVE
Endocrinology
Very high dose inhaled corticosteroids: panacea or poison?
Correspondence to:
Correspondence to:
Dr G Russell
Department of Child Health, University of Aberdeen, Royal Aberdeen Children’s Hospital, Aberdeen AB25 2ZG, UK; libra@ifb.co.uk
Perspective on the paper by Paton et al (see page 808)
Keywords: asthma; adrenal cortex hormones; adrenal insufficiency; fluticasone
| The first 150 words of the full text of this article appear below. |
Only the older readers of Archives will remember a time when inhaled corticosteroid therapy (ICT) was not the mainstay of asthma treatment. In the 1960s asthma was an unpredictable and more or less untreatable disease, and the diagnosis was made with reluctance by doctors and accepted with dismay by parents. The therapeutic options were limited. For acute relief, isoprenaline (isoproterenol) was given by pressurised metered dose inhaler, but its effects lasted for only a few minutes, and it fell into disrepute after only a decade, when its use appeared to be associated with increased mortality.1 In hospital, subcutaneous adrenaline backed up by oral or intravenous corticosteroids was the mainstay of therapy. Interval management was mainly with bronchodilators such as ephedrine, theophylline, and the belladonna alkaloids, and compound preparations such as Tedral, an unlikely mixture of theophylline, ephedrine, and phenobarbital, were popular. These drugs were of undoubted benefit, but disappointingly
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