Aerosolized Steroids and Induced Cushing's Syndrome

SHORTLY after the dramatic introduction of the adrenal corticosteroids into clinical medicine in 1949, they were used in the treatment of patients with asthma. The subsequent experiences of many medical observers have been similar. They found that the compounds suppress the signs and symptoms of asthma but do not affect a permanent remission without removal of the underlying causes. This suppression is regularly accompanied by the undesirable sideeffects of Cushing's syndrome. These effects may consist only of facial rounding and erythema, increased facial and neck hair, striae on the lower trunk and thighs, abdominal protrusion, acne, and easy bruising. More serious complications such as hypertension, hyperglycemia, masking of infections, bleeding duodenal ulcers, and osteoporosis with vertebral fractures have been reliably attributed to the steroids.1-4 An effort to minimize these side effects has led to the development of the steroids in a nebulized form. Expectations were for a direct