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Inhaled corticosteroids and HPA axis suppression: how important is it and how should it be managed?

Bondugulapati, Laxmi and Rees, Dafydd Aled 2016. Inhaled corticosteroids and HPA axis suppression: how important is it and how should it be managed? Clinical Endocrinology 85 (2) , pp. 165-169. 10.1111/cen.13073

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Abstract

Inhaled corticosteroids (ICS) are established as a cornerstone of management for patients with bronchoconstrictive lung disease. However, systemic absorption may lead to suppression of the hypothalamic–pituitary–adrenal (HPA) axis in a significant minority of patients. This is more likely in ‘higher risk’ patients exposed to high cumulative ICS doses, and in those treated with frequent oral corticosteroids or drugs which inhibit cytochrome p450 3A4. Hypothalamic–pituitary–adrenal axis suppression is frequently unrecognized, such that some patients, notably children, only come to light when an adrenal crisis is precipitated by physical stress. To minimize this risk, ‘higher risk’ patients and those with previously identified suppressed cortisol responses to Synacthen testing should undergo an education programme to inform them about sick day rules. A review of ICS therapy should also be undertaken to ensure that the dose administered is the minimum required to control symptoms.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Wiley-Blackwell
ISSN: 0300-0664
Date of First Compliant Deposit: 4 May 2016
Date of Acceptance: 30 March 2016
Last Modified: 01 Nov 2017 07:34
URI: http://orca.cf.ac.uk/id/eprint/90418

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