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Inhaled corticosteroids and adrenal insufficiency
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  • Published on:
    High dose fluticasone and adrenal suppression
    • Joanne M. Balfe, Paediatric Specialist Registrar
    • Other Contributors:
      • Mervyn RH Taylor, Deirdre McGonagle, Mary McDonald

    Dear Editor

    Following the editorial by Russell [1] recommending a short synacthen test for asthmatics receiving fluticasone in a daily dose of 1000 mcg or above, we undertook a computer search of our records of asthmatic patients.

    Asthmatics have approximately 4000 consultations per year with our team. We identified 190 children taking inhaled fluticasone either alone or in combination with salmeterol. Of...

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    Conflict of Interest:
    None declared.
  • Published on:
    Moderately high doses stilll need to be considered for very young children

    Dear Editor

    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 is limited data on the question of intra-pulmonary drug deposition in children under 3 years but the studies that have been publised seem to indicate that around 1-2% of the drug released int...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Pearce and Mabin

    Dear Editor

    I have been disappointed by the lack of response to the paper by Todd et al. [1] and to my accompanying editorial,[2] and I am indebted to Pearce and Mabin for opening what I hope will be an interesting discussion, although I must take issue with much of what they say. Their opening comment to the effect that clinical studies rather than a questionnaire-based survey should form the basis for advice...

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    Conflict of Interest:
    None declared.
  • Published on:
    Inhaled corticosteroids and adrenal insufficiency
    • Linda Pearce, Respiratory Nurse Consultant
    • Other Contributors:
      • David Mabin

    Dear Editor

    The editorial by Russell [1] suggests that when high dose inhaled steroids are being considered the use of fluticasone diproprionate should be avoided, on the basis of this survey.[2] Clinical studies rather than a questionnaire based survey should form the basis for such advice. Such studies show no increased risk of hypothalamic pituitary axis (HPA) suppression with fluticasone propionate when comp...

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    Conflict of Interest:
    None declared.