Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate: Table 1—

Todd, G; Acerini, Carlo L.; Buck, J.J.; Murphy, Nuala; Ross-Russell, Robert; Warner, James; McCance, David R.

doi:10.1183/09031936.02.00274402

Cited by 125 publications

(68 citation statements)

References 12 publications

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“…Poucos casos em crianças foram associados ao tratamento de longo prazo com PF 28 . Não há unanimidade quanto à ação supressora dos CEI sobre o eixo HHA.…”

Section: Supressão Do Eixo Hipotálamo-hipófise-adrenalunclassified

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo

Solé

2006

J Pediatr (Rio J)

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Objective: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma.Sources: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected.Summary of the findings: In vivo and in vitro studies show that t h e a v a i l a b l e I C S h a v e d i f f e r e n t p h a r m a c o k i n e t i c a n d pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate.Conclusions: ICS are the main anti-inflammatory agent used to treat persistent asthma. When administered in low doses, they seem to be safe and effective. Patient monitoring allows for early detection of possible side effects associated with ICS.J Pediatr (Rio J). 2006;82(5 Suppl):S198-205: Children, asthma, inhaled corticosteroids, budesonide, beclomethasone, fluticasone, ciclesonide. ResumoObjetivo: Revisar os mecanismos moleculares de ação, eficácia e potenciais efeitos adversos relacionados aos corticosteróides inalados (CEI) em crianças com asma persistente.Fontes dos dados: Artigos de língua inglesa da base de dados MEDLINE. Foram empregados os termos: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, oral candidiasis. Foram selecionados guias de tratamento, artigos de revisão, estudos controlados, meta-análises e revisões sistemáticas que avaliaram a eficácia e os eventos adversos do tratamento com CEI. Síntese dos dados:Estudos in vivo e in vitro mostram que os CEI disponíveis apresentam diferentes características farmacociné-ticas e farmacodinâmicas que lhes conferem diferentes potenciais de ação. Os CEI também diferem quanto aos efeitos adversos sistêmicos e locais. Salienta-se a biodisponibilidade desses produtos como essencial para determinar a incidência de efeitos colaterais. Em linhas gerais, os CEI são capazes de controlar a asma, reduzindo o número de exacerbações, atendimentos médicos, hospitalizações e a necessidade de pulsos de corticosteróides orais. Também se observa melhora da função pulmonar, sobretudo nos pacientes com asma ...

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“…Poucos casos em crianças foram associados ao tratamento de longo prazo com PF 28 . Não há unanimidade quanto à ação supressora dos CEI sobre o eixo HHA.…”

Section: Supressão Do Eixo Hipotálamo-hipófise-adrenalunclassified

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo

Solé

2006

J Pediatr (Rio J)

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“…However, very few ICS possess all of these ideal characteristics. Although FP demonstrates high receptor-binding affinity, careful monitoring of children is necessary to protect against adrenal suppression, particularly when high-dose FP therapy is necessary [67,68]. Moreover, FP is highly lipophilic [59], but, unlike ciclesonide and BUD, does not form fatty acid conjugates [63].…”

Section: Modern and Emerging Inhaled Corticosteroidsmentioning

confidence: 99%

Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma

Nave²,

et al. 2006

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The pharmacokinetic and pharmacodynamic effects of inhaled corticosteroids (ICS) have shaped the efficacy and safety of these agents in the treatment of asthma.Important pharmacokinetic and pharmacodynamic characteristics that can enhance the efficacy of ICS include small particle size, high glucocorticoid-receptor-binding affinity, long pulmonary residence time and lipid conjugation. These characteristics can increase or prolong the antiinflammatory effects of an ICS. Important pharmacokinetic characteristics that can enhance the safety of ICS include on-site activation in the lung, low oropharyngeal exposure, negligible oral bioavailability, high protein-binding and rapid systemic clearance.The degree of oropharyngeal exposure is relevant to local side-effects, such as oropharyngeal candidiasis, dysphonia and coughing. Pharmacokinetic properties that influence the degree of systemic exposure are relevant to the pharmacodynamic effect of ICS-induced hypothalamicpituitary-adrenal axis suppression and cortisol suppression, an indicator of potential long-term systemic side-effects, such as reduced growth velocity and bone density, fractures, and skin bruising and thinning.Therefore, significant differences in the pharmacokinetic and pharmacodynamic characteristics of the currently available inhaled corticosteroids warrant careful consideration when used in clinical practice as they may result in differences in efficacy and local and systemic safety profiles.

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“…Recent case reports, well documented with respect to measuring cortisol levels and undertaking stress testing, have confirmed that high doses of inhaled steroids such as fluticasone and budesonide can cause adrenal suppression culminating in adrenal crisis. 32, 33 Dluhy further concluded that the risk of adrenal insufficiency in patients taking low to medium doses of inhaled steroid was minimal, and did not indicate use of supplementary steroids.…”

Section: Exogenous Glucocorticoids and Adrenal Suppressionmentioning

confidence: 99%

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

Gibson

Ferguson

2004

Br Dent J

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Based to a great extent upon mainly anecdotal case reports and theory, there is a general acceptance that patients on longterm systemic steroid medication should receive supplementary glucocorticoids or 'steroid cover' when undergoing certain types of stressful treatment including dentistry. The theoretical basis to this practice is that exogenous steroids suppress adrenal function to an extent that insufficient levels of cortisol can be produced in response to stress, posing the risk of acute adrenal crisis with hypotension and collapse. The purpose of this paper is to review relevant literature and propose clinical guidelines for dental practitioners. Of numerous reported cases of adrenal crisis following procedural interventions, few stand up to critical evaluation. Other reviewers have reached similar conclusions. A number of studies confirm the low likelihood of significant adrenal insufficiency even following major surgical procedures. Various authors have suggested modified guidelines for management of patients on steroid medications. Patients on long-term steroid medication do not require supplementary 'steroid cover' for routine dentistry, including minor surgical procedures, under local anaesthesia. Patients undergoing general anaesthesia for surgical procedures may require supplementary steroids dependent upon the dose of steroid and duration of treatment.

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Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate: Table 1—

Cited by 125 publications

References 12 publications

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

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