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ABSTRACTS
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Oral Presentations O.24 Adrenal Insufficiency with Inhaled Corticosteroids: An Under-Recognised Event? 1 ´ A. Daveluy,1 C. Pollet,2 P-O. Girodet,3 A. Fourrier-Reglat, 2 ´ F. Haramburu,1 A. Abouelfath,2 F. Depont,2 G. Hebert, P. Robinson,2 M. Fayon,4 N. Moore,1 M. Molimard1 ´ de Bordeaux2, Departement ´ 1 INSERM U657, Universite de Pharmacologie, CHU de Bordeaux, Bordeaux, France; 2 ´ de Bordeaux2, Departement ´ Universite de Pharmacologie, ´ de Bordeaux2, Bordeaux, France; 3 INSERM U657, Universite ´ Departement de Pharmacologie, Service des Maladies Respiratoires, CHU de Bordeaux, Bordeaux, France; 4 Service ´ ´ ´ de Pneumologie Pediatrique, Departement de Pediatrie et CEDRE, CHU de Bordeaux, Bordeaux, France; 5 Service ´ ´ d’Endocrinologie, Diabetologie et Maladies Metaboliques, CHU de Bordeaux, Bordeaux, France Introduction: Owing to their excellent benefit/risk ratio, inhaled corticosteroids (ICS) are widely used for the treatment of chronic asthma. Yet there exists a risk of systemic effects such as adrenal insufficiency (AI) at higher doses (above 500μg/day in children or 1000 μg/day in adults (beclomethasone-equivalent)). The present study aimed to give an estimated frequency and describe characteristics of AI cases in patients using ICS during the past 5 years in France. Methods: In a retrospective cohort study, all metropolitan French paediatricians, endocrinologists, pulmonologists and intensive care physicians (n = 11783) were mailed questionnaires requesting information regarding cases of AI related to ICS therapy between 2000 and 2005. Patients having used systemic corticosteroids during the 3 months preceding diagnosis were excluded. Data collected were patient demographics, ICS treatment characteristics, underlying condition(s), concomitant treatment(s), results of biological investigations and AI outcome. All cases were validated by an expert committee. The French pharmacovigilance database was screened for spontaneous reports to determine the frequency of AI associated with the use of ICS, using the capture-recapture method. Results: Forty-six cases of AI were reported. Twenty-three subjects presented with AI alone and 23 with AI associated with Cushing’s syndrome. ICS used were fluticasone (n = 23), budesonide (n = 12) and beclomethasone (n = 4). In all but one of the cases, the ICS was used at high doses (>500 μg/day beclomethasone-equivalent in children and >1000 μg/day in adults). A potential drug interaction was found in 12 cases. Thirteen cases were found in the French pharmacovigilance database, one of which was common with the questionnaire survey. The capture-recapture method provides an estimation of 598 cases (95% CI [551-648]) of AI associated with the use of ICS for the 2000-2005 period in France. Conclusions: Adrenal insufficiency induced by inhaled corticosteroids has an estimated frequency greater than 100 cases per year for about 10M ICS units sold in France. Physicians should be advised that doses of 500μg/day beclo
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