Dictionary of Allergies .. Adrenal suppression and inhaled corticosteroids

Adrenal suppression and inhaled corticosteroids

Adrenal suppression is found mostly in patients who are receiving high doses of inhaled corticosteroid. The degree of suppression is not usually severe enough to cause concern itself, but is a marker of the systemic effect. Clinical evidence of excessive steroid use in high doses includes: bruising, weight gain, and possibly osteoporosis. Children with severe asthma who need inhaled corticosteroids to control their symptoms attain their expected height, albeit somewhat later than their non-asthmatic peers[1].

Studies examining the effects of inhaled corticosteroids (ICSs) on cortisol suppression show inconsistent results, and there is uncertainty regarding the dose-response relationship between ICSs and cortisol suppression. Statistically significant cortisol suppression was evident at low doses of ICSs and increased with dose. These results support an impact of all ICSs on endogenous cortisol levels and underscore the importance of titrating ICS doses to the minimum required to maintain symptom control[2].

References

1. Toogood Jh, et al: Aerosol corticosteroids in: Weiss E, Segal, M, Stein M, eds: Bronchial asthma: Mechanisms and therapeutics, 2nd ed. Boston: Little, Brown 1985:698-713.

2. Wlodarczyk JH, Gibson PG, Caeser M. Impact of inhaled corticosteroids on cortisol suppression in adults with asthma: a quantitative review. Ann Allergy Asthma Immunol. 2008 Jan;100(1):23-30.