Corticosteroids

MHRA/CHM advice: Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects (July 2018)
The MHRA have received reports of patients who have inhaled objects into the back of the throat—in some cases objects were aspirated, causing airway obstruction. Patients should be reminded to remove the mouthpiece cover fully, shake the device and check that both the outside and inside of the mouthpiece are clear and undamaged before inhaling a dose, and to store the inhaler with the mouthpiece cover on.

A spacer device is recommended for all patients using high-dose inhaled steroids via a metered-dose inhaler, see Bronchodilators. Drug choice should be determined partly by the patient’s ability to use the device and by patient acceptability.

Bone mineral density may be reduced following long-term high-dose inhaled steroids; assess the patient holistically and if other risk factors are present, refer for a DXA scan.

If compliance is good, most patients with asthma will have adequate control of their symptoms with doses less than 800 micrograms of inhaled beclometasone or budesonide or equivalent.

Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card.  This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids.  For more information, including which patients should receive the card, see HIS for details.  Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.

See Peri-operative guidelines for patients with or at risk of adrenal insufficiency.