The mean daily inhaled corticosteroid dose was lowest for the Autohaler (569 μg day −1 ; 95% CI: 538–605), followed by the Diskhaler (638 μg day −1 ; 95% CI: 609–670) and MDI (655 μg day −1 ; 95% CI: 638–673), and was highest for the Turbuhaler (990 μg day −1 ; 95% CI: 954–1029, P <0·001). A relatively high proportion of patients aged 19–49 years in the Turbuhaler and Diskhaler groups (29% and 23%, respectively) received at least one inhaled corticosteroid prescription including a daily dose greater than 1500 μg compared with the MDI group (4%). In the Diskhaler group the mean daily inhaled corticosteroid dose prescribed for adult patients was similar to that for the Turbuhaler group (904 μg day −1 and 1058 μg day −1 , respectively).
Children and adolescents <16 years taking high doses of fluticasone propionate (typically ≥ 1000 micrograms/day) may be at particular risk. Systemic effects may occur, particularly at high doses prescribed for long periods. Possible systemic effects include Cushing's syndrome, Cushingoid features , adrenal suppression, acute adrenal crisis and growth retardation in children and adolescents and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression. Consideration should be given to referring the child or adolescent to a paediatric respiratory specialist.
The most commonly reported side effects were: oral thrush , nausea , headache , and pain in the pharynx or larynx . More rarely reported side effects (occurring in <1% of patients during the clinical trial) include: tachycardia , palpitations , dry mouth , allergic reaction ( bronchospasm , dermatitis , hives ), pharyngitis , muscle spasms , tremor , dizziness , insomnia , nervousness , and hypertension . Patients experiencing an allergic reaction or increase in difficulty breathing while using this medication should immediately discontinue its use and contact their physician.