Potentially life threatening sudden & progressive deterioration in control of COPD; patient should undergo urgent medical assessment. Patients transferring from oral steroids may remain at risk of impaired adrenal function for considerable time. Discontinue treatment & consider other treatments if paradoxical bronchospasm occurs. Not indicated for acute episodes of bronchospasm or acute COPD exacerbation (ie, as rescue therapy). Patients w/ thyrotoxicosis, severe CV disorder eg, ischemic heart disease, tachyarrythmias or severe heart failure & prolonged QTc-interval. Possible systemic effects include Cushing's syndrome, cushingoid features, adrenal suppression, decreased bone mineral density, cataract & glaucoma in high doses for long periods. High doses may cause hyperglycaemia & hypokalaemia. Patients w/ symptomatic prostatic hyperplasia, urinary retention or narrow-angle glaucoma. Severe renal & hepatic impairment. Possible development of pneumonia in patients w/ COPD; infections can overlap w/ the symptoms of COPD exacerbation. Pregnancy & lactation. No relevant use in childn & adolescent <18 yr for COPD.
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