Search Past Medical Director Questions and Answers

Question and Answer Search

Please enter your search term and hit the search button. This will search 416 Question and Answer items published in the NADF newsletter between January 2004 and Present.

This is a simple search similar to the Google engine search. Searching for a single word (or part of a word) is recommended.

Searching for 2 words (or parts of words) separated by a single space can also be done. Both words must appear in the articles to produce a hit.

Here are a few recommended search terms.
Click on any one of them to invoke the search.

ACTH Muscle
Cortef Pain
Corticoid Patient
Doctor Primary
Endocrinologist Sodium
Hydrocortisone Steroid
Hypo Stress
Inhaler Vitamin

Your search was for "inhaler".
Found 6 matches in 3 Q&A's.

1) Q&A from the September, 2008 NADF newsletter:

QUESTION: Why is it that when I am in a stressed situation that has caused sleeplessness, I can take cortisol and it puts me to sleep within 30 minutes? Is this normal? Also, trying to cut back on asthma inhaler Symbicort 160/4.5 which I think has led to nasal blockage (similar to a cold without congestion) and problems sleeping and tiredness. My allergist has no idea how to address my Addisons....I have secondary Addison's from chemo. Hope you can help me figure this out.

ANSWER: There are two questions here. Stress leading to sleeplessness would tend to require extra glucocorticoid therapy to handle the stress. I presume when the extra dose is taken, it helps to relieve the stress symptoms and adds to a more relaxed state. It does not cause the sleep directly. The use of steroid containing inhalers for asthma in the setting of secondary adrenal insufficiency can be tricky. As long as the usual baseline dose of glucocorticoid is sufficient and was not reduced when the inhaler was added, tapering slowly from the inhaler should not present much of an adrenal insufficiency effect. I would be more concerned about a return of asthma symptoms

2) Q&A from the September, 2023 NADF newsletter:

QUESTION: I use budesonide as a treatment for my adrenal insufficiency, as prescribed by my endocrinologist, due to some other complications. Perhaps you can add it to your roster sometime.

ANSWER: Budesonide is a glucocorticoid that has two clinical uses - inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and asthma. When taken orally, it treats inflammatory bowel disease within the intestine. It is very poorly absorbed into the bloodstream, which makes it attractive as a gastrointestinal therapy because it has much less glucocorticoid effect on the body while suppressing the GI inflammation within the bowel. It has been used for many years, touted as a safer alternative to prednisone for these diseases. Similarly, budesonide has been used in inhalers for asthma because it is poorly absorbed and less likely to have significant steroid side effects. Budesonide should not be used to treat adrenal insufficiency. For primary and secondary adrenal insufficiency, you need a potent, consistent, and rapid absorption of the glucocorticoid. Budesonide does not do this.

3) Q&A from the December, 2024 NADF newsletter:

QUESTION: Can long-term use of Budesonide cause adrenal insufficiency? I have eosinophilic gastritis and have been on budesonide for 6 yrs. I stopped but did not taper right and went into an adrenal crisis.

ANSWER: Budesonide is a potent glucocorticoid used to treat a variety of illnesses that respond to local rather than systemic steroid therapy. It is used in many inhalers for asthma and other pulmonary disorders. It is also used as a long-acting oral medication for chronic inflammatory bowel diseases like Crohn's disease, ulcerative colitis and eosinophilic gastritis. Usually, it is given for a fairly short course of 8 to 12 weeks, then tapered. Although it is poorly absorbed into the circulation, there is some systemic effect that is directly related to the dose and length of time it is used. I would expect that anyone who used it for 6 years would be likely to have suppression of the hypothalamic-pituitary-adrenal axis resulting in some degree of secondary adrenal insufficiency. That would mandate the need for a slow taper and monitoring for signs and symptoms of SAI. A rapid taper would raise the risk of an acute adrenal crisis.

Questions are normally submitted by NADF members.
Answers are from NADF's Medical Director Paul Margulies, M.D., FACE, FACP.

If you would like to submit a question E-mail Question.

If you see any errors in these Q&A's, please report them to Webmaster

NADF does not engage in the practice of medicine. It is
not a medical authority, nor does it claim to have medical
knowledge. In all cases, NADF recommends that you consult your
own physician regarding any course of treatment or medication.

Home Page | Mapping | Crime Victims Rights