My GP practice has said that national guidance promotes a new steroid emergency card to help healthcare staff identify patients with adrenal insufficiency.
I do take oral steroids daily via symbicort. Is taking symbicort going to lead to adrenal insufficiency ? Does anyone have experience of adrenal insufficiency ?
The risk of AI developing from ICS is very low. Many many people never develop AI despite a life time of ICS, but very rarely someone does. The cards are given as very few docs even think about a potential for AI issue so when someone does show symptoms due to stopping their meds it doesn’t get treated. This is typically in hospital when the patient is unable to take their inhaler.
I’m at a much greater risk of AI, due to 4+ years on daily oral steroids, as well as ICS, yet on my last check I did not have AI. I still carry the card tho, for just in case.
Both these pages talk a little bit about steroid cards; healthunlocked.com/asthmauk... healthunlocked.com/asthmauk... and this one talks about AI; healthunlocked.com/asthmauk...
Hope this helps
Hi,
Carrying or needing the card doesn't necessarily mean that you have, or will develop, adrenal insufficiency (AI). It's advised for people on continuous oral steroids and high dose inhaled steroids, who shouldn't just stop their steroids suddenly and may need extra if they are injured to prevent them going into adrenal crisis. Being steroid dependent does not necessarily mean you have AI longer term, but it does mean you can't just stop taking a steroid suddenly. As Emma has said, even being higher risk for it doesn't necessarily mean you will get it. I'm pretty sure she's had more pred than me in total but I have AI and she currently doesn't.
You can develop AI on just inhaled steroids, but it's pretty unlikely and rare, especially at lower doses - usually it happens when people have been on oral systemic steroids such as prednisone/prednisolone for an extended time, or had a lot of repeated courses.
The link below (it's a PDF, and I've also added a link to NHS England) tells you more, including what is considered 'high dose' inhaled steroid. It would really depend on how much Symbicort you take as to whether it's 'high dose'
england.nhs.uk/2020/08/ster...
shropshireccg.nhs.uk/media/...
For more about AI, you may find this post helpful - though a lot only applies if you have or are in the process of being tested for adrenal insufficiency.
No adrenal insufficiency from inhaled and tablet steroids is very rare... what is more common is adrenal suppression and if you where to undergo a "trauma" (accident/serious injury) and couldn't carry on taking your steroids the stress on your body from the "steroid withdrawl" (lack of cortisol from the adrenal glands being asleep) and the trauma could be.... catastrophically bad
So I do believe the advice is changing with regard to carrying steroid cards
It can be difficult to formally diagnose AI if someone is constantly on oral steroids for asthma, given you need to be under a certain level and able to stop temporarily for the tests. As you say though they are still steroid-dependent and shouldn't just stop. I was never really warned about this properly when I was on pred continuously - I knew I had to taper but one asthma cons told me no need and another cons said she'd send me to endo for testing when I was off (I managed to wean one time before) then didn't bother.
If someone is able to lower their dose or come off oral steroids completely due to example to being on biologic treatments for asthma, they may be able to get the testing and find they have AI - though as my post I linked to said, it is possible to recover from this type of AI in some cases.
I was diagnosed with AI because I don't respond to oral steroids for asthma, so successfully tapered down off them, then had a couple more short courses (because standard practice with asthma flares even if you say you don't respond), and found I couldn't come off them for adrenal reasons - at that point I was sent for testing and diagnosed with AI. I have been able to lower my daily hydrocortisone dose and I do have some baseline cortisol, but my adrenals still don't respond the way they need to for physiological stress.
adrenal insufficiency/prednsiolone
Tapering off inhaled steroids due to steroid induced adrenal insufficiency
Why are relievers standard with preventers.
