title: Adrenal insufficiency associated with long-term use of inhaled steroid in asthma.
abstract: We previously reported that as many as one third of hospitalized patients with asthma treated with a low to medium daily dose of inhaled steroids (ICSs) for an average of 4.5 years showed adrenal insufficiency (AI).
  
  
  
  To re-examine this issue in consecutive outpatients with asthma because of possible subject selection bias.
  
  
  
  One hundred twenty-one consecutive adult patients with asthma under ICS treatment for at least 6 months underwent a rapid adrenocorticotrophic hormone stimulation test. AI was defined as a morning serum cortisol level no higher than 3 μg/dL or lower than 18 μg/dL before and after administration of 250 μg of adrenocorticotrophic hormone.
  
  
  
  The mean durations of ICS use in the short-term (less than the median) and long-term (at least the median) users were 3.8 and 11.5 years, respectively. The proportion of subjects affected by AI tended to increase with the increasing cumulative dose of ICS (short-term users at a low to medium daily dose: mean cumulative dose 502 mg [15 of 34, 44.1%]; short-term users at a high dose of 941 mg [16 of 26, 61.5%]; long-term users at a low to medium dose of 1,077 mg [25 of 41, 61.0%]; long-term users at a high dose of 2,805 mg [13 of 20, 65.0%]), although not significantly. In short-term users, daily and cumulative ICS doses were significantly related to serum cortisol levels 60 minutes after taking adrenocorticotrophic hormone (r = -0.300 and -0.287, respectively; P < .05).
  
  
  
  A large number of patients with asthma might have AI even with low- to medium-dose ICS treatment when ICSs are administered over a long period. Thus, it is essential that patients with asthma under ICS treatment be checked for AI much more frequently.
authors.affiliation: Department of Allergy, Chonnam National University Medical School, Gwangju, Korea; Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea. Electronic address: ischoi@chonnam.ac.kr.
authors.forename: Inseon S
authors.initials: IS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Da-Woon
authors.initials: DW
authors.lastname: Sim
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Wui
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000097:blood; D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D013256:Steroids