ADRENAL INSUFFICIENCY IN ASTHMA PATIENTS

Abstract

Long–term glucocorticoid use suppresses the hypothalamus–pituitary axis and induces secondary adrenal insufficiency. Systemic glucocorticoids are used in severe asthma management, though recently asthma control has more frequently been achieved using biological therapies. This review includes risk for secondary adrenal insufficiency evaluation in patients treated with systemic glucocorticoids, early diagnostics of adrenal insufficiency, optimal steroids discontinuation strategy. Adrenal insufficiency is frequently underdiagnosed in patients treated with glucocorticoids because of non–specific symptoms thus, adrenal insufficiency risk should be evaluated in all cases when systemic glucocorticoids are used for longer than 4 weeks. If prednisolone equivalent doses are higher than 20 mg, a more rapid discontinuation scheme can be used; if 20 mg or less – discontinuation should be slower. When prednisolone equivalent dose of 5 mg is reached, hypothalamus–pituitary–adrenal axis function should be evaluated. In summary, the glucocorticoid discontinuation process is long and rather complicated, so sometimes, both pulmonologists and endocrinologists should be involved.