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Asthma and Cushing's syndrome.
A M Wilson1, A Blumsohn, R T Jung
1Departments of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK. b.j.lipworth@dundee.ac.uk
Chest
|February 12, 2000
Summary
High-dose inhaled fluticasone propionate in asthma patients can lead to Cushing's syndrome and adrenal suppression. Switching to budesonide resolved these adverse effects without compromising asthma control.
Area of Science:
- Endocrinology
- Pulmonology
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are a cornerstone of asthma management.
- High-dose ICS therapy is often required for severe asthma.
- Potential systemic side effects of ICS require careful monitoring.
Observation:
- A female asthma patient on high-dose inhaled fluticasone propionate developed Cushing's syndrome features over two years.
- Symptoms included proximal myopathy, osteopenia, hypertension, depressive psychosis, and cushingoid appearance.
- Biochemical tests revealed marked adrenal suppression (9:00 AM serum cortisol 20 nmol/L).
Findings:
- Switching therapy to inhaled budesonide (0.8 mg/d) normalized serum cortisol levels (315 nmol/L).
- Patient's cushingoid appearance, mental state, and myopathy significantly improved.
- Asthma control was maintained after the medication change.
Implications:
- This case highlights the risk of clinically significant adverse effects from high-dose inhaled corticosteroids, even at labeled doses.
- It underscores the importance of vigilant monitoring for systemic corticosteroid toxicity in patients using ICS.
- Alternative ICS or therapeutic adjustments may be necessary to mitigate risks while maintaining respiratory health.