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The use of inhaled corticosteroids and the risk of adrenal insufficiency.
MedLine Citation:
PMID:  23060630     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Adrenal insufficiency is a potential complication of therapy with inhaled corticosteroids (ICS). Although prior studies found the highest risk of adrenal insufficiency with fluticasone, a more potent ICS, these results might be explained by a channeling bias and concomitant exposure to oral corticosteroids.We re-examined the relationship between the use of ICS and adrenal insufficiency by using a cohort of patients treated for respiratory conditions during 1990-2005, identified in the healthcare databases from the province of Quebec, Canada, with follow-up until 2007. A nested case-control analysis was performed within this cohort. Cases of adrenal insufficiency were matched with up to 10 controls.392 cases were identified (incidence rate=1.1/10,000 person-years). Although the rate of adrenal insufficiency was not significantly higher among all current users of ICS, patients receiving the highest dosages showed a greater risk (OR=1.84; 95% CI: 1.16-2.90). Consistently, an increased risk was estimated for the highest tertile of ICS dose (OR=1.90; 95% CI: 1.07-3.37) cumulated in the year before the event.Inhaled corticosteroids at high doses appear to be a significant independent risk factor for adrenal insufficiency. Physicians prescribing ICS at such dosages should be sensitive to the signs and symptoms of adrenal insufficiency in their patients.
Authors:
Francesco Lapi; Abbas Kezouh; Samy Suissa; Pierre Ernst
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-11
Journal Detail:
Title:  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology     Volume:  -     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec (Canada).
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