• adrenal crisis
• high-dose fluticasone
• inhaled corticosteroids

In response to comments by Pearce and Mabin on Professor Russell’s editorial¹ on our paper.²

They doubt that our survey underestimated the true scale of the problem. I can inform themthat this is not the case. Since our survey was completed we have been notified of a further seven cases (five children, two adults). All but one of the children had been taking fluticasone in similar dosages to those reported in our survey. Three of these were critically ill in intensive care and an 8-year-old girl died due to adrenal crisis. The remaining child was only 20 months old and had been given budesonide in extremely high doses of 2000–8000 mcg/day.³ Both adults had been taking fluticasone (1000 mcg/day, 2250 mcg/day).

Case reporting clearly plays a much greater role than clinical studies in post license surveillance of new drugs. In an …