To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: CHEST: Inhaled Fluticasone Linked to Acute Adrenal Insufficiency URL: http://www.pslgroup.com/dg/20CD1E.htm Doctor's Guide November 6, 2001
By Alison Palkhivala Special to DG News PHILADELPHIA, PA -- November 6, 2001 -- Acute adrenal crisis, not typically associated with use of inhaled steroids, is popping up in individuals with severe asthma treated with very high doses of inhaled steroids, particularly high-dose fluticasone. Geoffrey Todd, MD, from Antrim Hospital in the United Kingdom and colleagues have observed four cases of acute adrenal crisis in severe asthmatics, three children and one adult, treated with high-dose inhaled fluticasone. Dr. Todd presented these observations here yesterday at the annual meeting of the American College of Chest Physicians (ACCP). "The oral bioavailability of fluticasone is practically negligible, and this fact has led to the widespread belief … that fluticasone is a safer inhaled steroid than the others that are available," said. Dr. Todd. But his findings suggest otherwise. The three children with severe asthma who developed acute adrenal crisis were aged seven to nine years and were taking inhaled fluticasone at dosages of 500-2,000 mcg/day for five days to five years. They presented with convulsions due to hypoglycemia (1.3-1.8 mmol/l). In addition, a 33-year old asthmatic developed acute adrenal insufficiency shortly after switching from fluticasone 1,500 mcg/day to budesonide 800 mcg/day, even though the systemic effects of budesonide are less than those of fluticasone. It appears his adrenal crisis was precipitated by the change in medication. Laboratory analysis revealed that all patients were suffering from secondary hypoadrenalism, which could not be explained by previous treatment with oral steroids. Another study, also presented at the CHEST meeting by Dr. Todd, reveals that these four cases may be the tip of the iceberg. Dr. Todd and colleagues sent surveys to endocrinologists and pediatricians asking about their experience with acute adrenal insufficiency possibly due to inhaled steroids. Those who reported such experience were asked to fill out a more detailed questionnaire. Overall, 2,912 surveys were sent out, and there was a 24 percent response rate, with 51 physicians reporting an experience with acute adrenal insufficiency linked to inhaled steroid use. Sufficient data was available on 31 appropriate cases (26 children and three adults), and 29 were taking inhaled fluticasone at doses ranging from 200 to 1,500 mcg/day. The remaining two patients were taking inhaled beclomethasone at doses of 2,000 mcg/day or more. Signs of acute adrenal crisis in these patients included hypoglycemic convulsions and coma, hypotension, fatigue, nausea, and fulminant sepsis. The investigators conclude that physicians should be on the lookout for acute adrenal crisis in asthma patients treated with inhaled high-dose fluticasone, and this therapy should be avoided in severe asthmatics when possible. They speculate that the systemic effects observed with fluticasone may be a result of the drug's high lipophilicity compared to other inhaled steroids, which leads to a longer plasma half life, greater tissue distribution, and prolonged glucocorticoid receptor occupancy. Despite the concern this research raises regarding high dose inhaled steroid use, Dr. Todd adds, "we believe that the benefits of inhaled steroids, for the majority of patients, greatly outweigh possible side effects. … We strongly support use of inhaled steroids as a first-line approach for asthma." --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.