Medical Health Encyclopedia

Long-term use of steroid medications also suppresses secretion of natural steroid hormones by the adrenal glands. After withdrawal from these drugs, this so-called adrenal suppression persists and it can take the body a while (sometimes up to a year) to regain its ability to produce natural steroids again. Uncommonly, switching from oral to inhaled steroids has caused severe adrenal insufficiency and, in rare cases, has resulted in death. The risk increases during times of stress. Patients should discuss with their physician measures for preventing adrenal insufficiency, particularly during stressful times. No one should stop taking any steroids without consulting a physician first, and if steroids are withdrawn, regular follow-up monitoring is necessary.

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Inhaled Corticosteroids. Inhaled corticosteroids are often used for treating chronic COLD. They include the following:

• The most recent generation of inhaled steroids include (in order of potency) fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort and others), and flunisolide (AeroBid). In general, the newer agents, possibly with the exception of flunisolide, are more powerful than the older generation agents when used with standard inhalers.
• The older corticosteroid inhalants are beclomethasone (Beclovent, Vanceril) and dexamethasone (Decadron Phosphate Respihaler and others). They are less powerful than the newer steroids when delivered with standard inhalers. New inhaler systems for, however, such as QVAR, which uses extra fine formulations of beclomethasone to allow deep delivery into the lungs may prove to be as effective as the newer, more potent steroids.
• Inhalers that combine a long-acting beta 2 agonists and a corticosteroid (Advair, Seretide, Symbicort) are even more effective than either agent---reducing exacerbations by 30%. Some studies suggest they may offer significant improvements in lung function and even improve survival rates, but more research is needed to confirm such findings.