Adrenal suppression in two patients with asthma treated with low doses of the inhaled steroid fluticasone propionate☆,☆☆,★
Section snippets
Case 1
An 8-year-old girl had asthma diagnosed at age 2 years. There were two hospitalizations, three visits to an emergency department, and four courses of oral prednisone between ages 2 and 4 years. At age 4 she was started on maintenance doses of cromolyn sodium. At that time. skin testing revealed sensitivity to cat, dog, horse, and ragweed allergens. There were no pets in the home, and no members of the household were smokers. Dust mite control was undertaken. She continued to have difficulty at
Discussion
Inhaled steroids are the most potent antiinflammatory agent for suppression of eosinophilic inflammation in asthma, which can usually be achieved with safe doses. However, the two cases described indicate that clinically important systemic effects can occur even at relatively low doses of inhaled steroid. Case 1 showed a child who demonstrated poor growth velocity even on low doses of inhaled steroid (200 μg budesonide per day). Moreover, the data suggested that 250 μg of inhaled fluticasone
References (4)
- et al.
A dose-ranging study of fluticasone propionate in adult patients with moderate asthma
Chest
(1993) Highlights of the Expert Panel Report II: guidelines for the diagnosis and management of asthma. National Heart, Lung and Blood Institute
(1997)
Cited by (0)
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From athe Gage Occupational and Environmental Health Unit and the Health Sciences Research Centre, St. Michael's Hospital, Toronto, bthe Hospital for Sick Children, Toronto; and cthe Wellesley Hospital, University of Toronto, Toronto.
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Reprint requests: Barry Zimmerman, MD, FRCPC, 45A Alvin Avenue, Toronto, Ontario, Canada M4T 2A7.
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1/54/87174