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Arch Dis Child. 2007 April; 92(4): 372.
PMCID: PMC2083689

Compliance with inhaled corticosteroids is important when considering adrenal suppression

We read with interest the article by Paton et al1 reporting the results of low‐dose Synacthen tests in children prescribed fluticasone proprionate. The finding of flat adrenal responses in 2.8% of the children tested (all prescribed [gt-or-equal, slanted]1000 μg of fluticasone proprionate per day) provides further evidence of the potential dangers of high doses.

We recently published the results of standard‐dose Synacthen tests in children recommended [gt-or-equal, slanted]1000 μg of fluticasone proprionate per day. Of the 29 children tested, 3 were found to have complete adrenal suppression.2 In his editorial, Russell3 highlights compliance with the treatment as likely to be important, given the fact that not all patients taking high‐dose fluticasone proprionate have adrenal failure. In our study, the first of its kind to our knowledge in this context, we examined compliance in terms of the actual amount of fluticasone proprionate prescribed over the past year in primary care relative to that recommended by the hospital specialist. The three children with adrenal suppression had actually been prescribed only a median of 493 μg fluticasone proprionate per day over the past year, compared with a median of 433 μg in the normal group. Overall, there was an inverse correlation between the actual prescribed daily dose of fluticasone proprionate and the peak cortisol response to Synacthen (r = −0.44, p = 0.03).2

Our study was relatively small in size and used a pragmatic measure of compliance; however, the results suggest that compliance with treatment should be considered and that in reality children with adrenal suppression may be receiving smaller doses of fluticasone proprionate than we think.

Footnotes

Competing interests: None declared.

References

1. Paton J, Jardine E, McNeil E. et al Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone. Arch Dis Child 2006. 91808–813.813 [PMC free article] [PubMed]
2. Brodlie M, McMurray A, Crofton P M. et al Strategies to screen for adrenal suppression in children with asthma should take account of compliance with inhaled corticosteroids. Eur J Pediatr [Epub ahead of print]. Doi:10.1007/s00431‐006‐0260‐7 [PubMed]
3. Russell G. Very high dose inhaled corticosteroids: panacea or poison? Arch Dis Child 2006. 91802–803.803 [PMC free article] [PubMed]

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