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September 24, 1982

Hazards of Prolonged Use of Beclomethasone Spray-Reply

JAMA. 1982;248(12):1450. doi:10.1001/jama.1982.03330120019011

In Reply.—  Initial reports on the use of beclomethasone were completely sunny; with the passage of time, some clouds have begun to appear. Although a direct causal relationship is difficult to prove, in one study, three deaths from asthma were reported in children using this drug.1 Nor can the findings of Wyatt et al2 be discounted in a few words. That excellent study showed suppression of serum cortisol levels in patients treated with as little as 500 μg/day of beclomethasone; the usual recommended dose is up to 1,000 μg/day.One of the criticisms of such studies is that they provide laboratory evidence only of disruption of hypothalamic-pituitary-adrenal axis function. The clinically relevant issue is whether inhalant corticosteroids impair the ability of patients to respond to stress. Using insulin-induced hypoglycemia as the source of stress, Vaz et al3 showed that maximal level of cortisol elicited by the stress