Guidance is needed on inhaled glucocorticoids and acute adrenal crises

Wass and Arlt highlight several strategies to prevent morbidity and mortality from acute adrenal crisis, 1 including the recognition and management of iatrogenic adrenal suppression; this is increasingly important given the rise in glucocorticoid prescriptions in the UK. 2 Clear guidance, particular...

Full description

Saved in:
Bibliographic Details
Published in:BMJ (Online) 2012-11, Vol.345 (nov06 9), p.e7436-e7436
Main Author: Mackenzie, Scott D
Format: Article
Language:English
Subjects:
Addison Disease - drug therapy
Adrenal glands
Anti-Inflammatory Agents - administration & dosage
Asthma
Glucocorticoids
Humans
Hydrocortisone - administration & dosage
Letters
Respiratory therapy
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Wass and Arlt highlight several strategies to prevent morbidity and mortality from acute adrenal crisis, 1 including the recognition and management of iatrogenic adrenal suppression; this is increasingly important given the rise in glucocorticoid prescriptions in the UK. 2 Clear guidance, particularly regarding inhaled glucocorticoids, is lacking. [...]adults receiving licensed doses of inhaled glucocorticoids also show significant dose dependent depression of cortisol production, 3 and these drugs are a significant independent risk factor for hospital admission for adrenal insufficiency. 4 One drug manufacturer has recommended periodic testing of adrenocortical function for patients on inhaled glucocorticoids. 5 It is therefore surprising that UK asthma guidelines do not clearly back the use of steroid alert cards for those on high dose inhaled glucocorticoids, stating "the benefits and possible disadvantages, particularly with regard to adherence, of such a policy remain to be established."
ISSN:0959-8138
1756-1833
1756-1833
DOI:10.1136/bmj.e7436