RT Journal Article
SR Electronic
T1 The use of inhaled corticosteroids and the risk of adrenal insufficiency
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj00809-2012
DO 10.1183/09031936.00080912
A1 Francesco Lapi
A1 Abbas Kezouh
A1 Samy Suissa
A1 Pierre Ernst
YR 2012
UL http://erj.ersjournals.com/content/early/2012/10/11/09031936.00080912.abstract
AB Adrenal insufficiency is a potential complication of therapy with inhaled corticosteroids (ICS). Although prior studies found the highest risk of adrenal insufficiency with fluticasone, a more potent ICS, these results might be explained by a channeling bias and concomitant exposure to oral corticosteroids.We re-examined the relationship between the use of ICS and adrenal insufficiency by using a cohort of patients treated for respiratory conditions during 1990–2005, identified in the healthcare databases from the province of Quebec, Canada, with follow-up until 2007. A nested case-control analysis was performed within this cohort. Cases of adrenal insufficiency were matched with up to 10 controls.392 cases were identified (incidence rate=1.1/10,000 person-years). Although the rate of adrenal insufficiency was not significantly higher among all current users of ICS, patients receiving the highest dosages showed a greater risk (OR=1.84; 95% CI: 1.16–2.90). Consistently, an increased risk was estimated for the highest tertile of ICS dose (OR=1.90; 95% CI: 1.07–3.37) cumulated in the year before the event.Inhaled corticosteroids at high doses appear to be a significant independent risk factor for adrenal insufficiency. Physicians prescribing ICS at such dosages should be sensitive to the signs and symptoms of adrenal insufficiency in their patients.