Beclometasone inhaled

Mr JA s previous medical history includes porphyria and childhood asthma. His past drug history comprises salbutamol inhaler and beclometasone inhaler for childhood asthma. 

Three days later, after being stabilised on the ward, he is discharged on salbutamol and beclometasone inhalers (same as on admission) plus a leukotriene antagonist. 

Salbutamol is a selective beta2-receptor agonist indicated in the management of asthma as a bronchodilator relieving acute attacks. It may be used in combination with inhaled corticosteroids such as beclometasone. Salbutamol acts within a few minutes and tends to be short-acting, unlike salmeterol. Side-effects of salbutamol include tachycardia and palpitations. It does not cause drowsiness and does not precipitate oral candidiasis. Inhaled corticosteroids may precipitate oral candidiasis. 

Q81 Beclometasone aerosol is used in the acute asthmatic attack. When used in conjunction with a bronchodilator administered by inhalation,... 

There are a number of corticosteroids that are used in pulmonology as inhalation medications. For rhinitis sprays may be used which also contain corticosteroids. Coricosteroids in these topical medications include beclometasone, fluticasone, mometa-sone and also budesonide. 

He is started on salbutamol metered dose inhaler (MDI) two puffs when required and beclometasone (Qvar) 50 micrograms twice daily. 

Dhillon, S., and Keating, G. M. (2006), Beclometasone dipropionate/formoterol In an HFA-propelled pressurised metered-dose inhaler, Drugs, 66,1475-1483. 

If patients need to use the reliever more than three times a week, they are usually also prescribed a preventer inhaler containing a corticosteroid, such as beclometasone diproprionate, budesonide or fluticasone proprionate. Corticosteroids decrease airway inflammation, reducing airway oedema and mucus production. When used regularly they are prophylactic and reduce the frequency of asthma. 

PROTEASE INHIBITORS CORTICOSTEROIDS t plasma levels of betamethasone, dexamethasone, hydrocortisone, prednisolone and both inhaled and intranasal budesonide and fluticasone with ritonavir (with or without lopinavir) Inhibition of CYP3A4-mediated metabolism Monitor closely for signs of corticosteroid toxicity and immunosupression, and 1 dose as necessary. Consider using inhaled beclometasone... 

Horses appear to be more sensitive to the adrenosuppressive effects of aerosolized corticosteroids than human patients. Documentation of systemic absorption (adrenal suppression) of inhaled beclometasone and fluticasone raises concerns that other systemic glucocorticoid effects may occur following aerosol administration of corticosteroids. The administration of adrenosuppressive doses (>1600 p,g/day) of beclometasone dipropionate to asthmatic human patients does not produce the other systemic side-effects of glucocorticoid administration, including a roimd face (Cushingoid facies), polyuria, polydipsia, hyperglycemia, obesity, altered carbohydrate metabolism, osteoporosis, abortion, posterior subcapsular cataract and aseptic necrosis of the... 

Beclometasone dipropionate is the most widely dispensed inhaled anti-inflammatory agent for astfunatic human patients. Inhaled beclometasone dipropionate reduces inflammatory cell populations in bronchoalveolar lavage fluid, controls clinical signs of airway obstruction and improves parameters of pulmonary function in human asthmatics. Consequently, aerosolized beclometasone dipropionate is the first line of therapy for mod-erate-to-severe allergic airway disease in human patients. Aerosolized beclometasone does not cause adrenal suppression in asthmatic human patients at therapeutic dosages (800-1600 xg/day) and initiation of beclometasone therapy as a replacement for systemic corticosteroid administration permits recovery of the hypothalamic-pituitary-adrenal axis (Barnes et al 1998). 

Examples are beclometasone and budesonide given by inhalation and prednisolone given orally. 

A 51-ycar-old man who had been taking Iovastatin 40 mg daily for 5 years developed muscle aches and fever one day after finishing a 5-day course of azithromycin 250 mg daily. His creatine phosphokinase levels were elevated and he was diagnosed as having rhabdomyolysis. This patient was also taking colestyramine, diltiazem, doxazosin, glibenclamide (glyburide), thyroid , allopurinol, naproxen, prednisone, loratadine and inhaled beclometasone. ... 

Endocrine The effects of inhaled glucocorticoids on the hypothalamic-pituitary-adrenal axis in adults and children were reviewed in SEDA-31 (p. 305). In summary, at low doses inhaled glucocorticoids have little effect, but at high doses (2000 micrograms beclometasone equivalents) adrenal suppression can occur. In a French survey of 11 783 hospital specialists combined with a pharmacovigilance database, there were 46 cases of adrenal insufficiency attributable to inhaled corticosteroids at doses of over 500 micrograms beclometasone equivalents in children and over 1000 micrograms beclometasone equivalents in adults 12 cases were associated with concomitant use of enzyme inhibitors [10 ]. 

In contrast, in a randomized controlled trial in 645 patients with moderate asthma uncontrolled by regular inhaled glucocorticoids compared with combined beclometasone diproprionate and formoterol, there was no evidence of adrenal suppression [12. This may suggest that the doses of glucocorticoids were too low. 

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