Abstract
Background:
High dose inhaled steroids can lead to adrenal suppression. It is not clear how the use of other steroids (nasal, topical or oral) in addition to inhaled steroids, affect adrenal suppression.
Aims
The aim of this study was to review past synacthen tests and try to determine steroid risk factors for those with suppressed cortisol.
Methods
A review of synacthen tests done over a 3 year period on patients with asthma was carried out. Data extracted and determined included age; BMI sd; calculated surface area, beclometasone equivalent steroid dose, oral steroid intake, other steroids (nasal, topical), and result of synacthen test.
Results
19 synacthen tests were available for analysis. The average age was 11.3 years (range 4.6-16.2). 10 were boys. 6 patients were on doses of inhaled corticosteroids not recommended in the British National Formulary for Children (BNFc), and 3 of these had adrenal suppression. Of the remaining 13 patients only 2 had adrenal suppression. Only 2 patients were documented as taking nasal steroids and 1 as taking topical steroids. The odds ratio of adrenal suppression when a patient had 5 or more courses of oral prednisolone in the last year and is on an dose of inhaled steroids not recommended in the BNFc compared to those who had fewer courses of oral steroids or on recommended doses of inhaled steroids was 5.6. There was no association with inhaled steroid dose adjusted for surface area and adrenal suppression.
Conclusions
Using a dose of inhaled steroids not recommended in the BNFc and having 5 or more courses of steroids together increases a patients’ risk of adrenal suppression.This association is not seen when the inhaled steroid dose is adjusted for beclometasone equivalence per surface area.
- © 2013 ERS
