Not indicated for rapid relief of bronchospasm. Reassess therapy if worsening of underlying conditions occur; if treatment is ineffective or patient needs more inhalations than usual. Possible risk of impaired adrenal function for patients being transferred from oral corticosteroids. Recurrence of earlier allergic symptoms (eg, rhinitis, eczema) in patients previously receiving high doses of systemic steroids. Consider additional systemic glucocorticosteroid cover during periods of stress, severe asthma attack or elective surgery. Consider referral to an ophthalmologist if patient presents w/ symptoms (eg, blurred vision or other visual disturbances). Patients w/ active or quiescent pulmonary TB or fungal, bacterial or viral resp infections. Reduced liver function may affect corticosteroid elimination. Pregnancy & lactation. Turbuhaler: Instruct patient to rinse mouth w/ water after each administration to minimize risk of Candida infections. Avoid concomitant treatment w/ ketoconazole, itraconazole or other potent CYP3A4 inhibitors. May experience return of previous symptoms (eg, muscle & joint pain) during transfer from oral steroid therapy. Childn on immunosuppressant drugs. Monitor growth regularly in childn & adolescent receiving long-term treatment. Respules: Potential systemic effects of inhaled steroids (eg, HPA axis depression, bone density reduction, cataracts & glaucoma, growth rate retardation in childn). Carefully interpret bone mineral density measurements, as an increased bone area in growing childn may reflect an increased bone vol. Possible initial reduction of growth velocity w/in 1st yr of treatment. Perform height measurements to identify patients w/ increased sensitivity. May mask some signs of existing & new infections at high doses. Not to be used w/ +ve pressure delivery systems in pulmonary conditions unless special drainage is performed.
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