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Asthma experts have backed a GP who was criticised at a fatal accident inquiry for prescribing high doses of inhaled steroids to a five-year-old who later died.

In prescribing fluticasone propionate at doses of up to 2,000µg off-label, Dr Frank Shapiro of Strathaven, Lanarkshire, had not considered emerging evidence, the inquiry into the death of Emma Frame at Hamilton Sheriff Court was told.

But while the incident occurred in 2001, GPs were not officially warned about adrenal insufficiency problems of high steroid doses until the SIGN/BTS asthma guidelines were published in 2003.

Dr Dermot Ryan, a member of the steering committee of the General Practice Airways Group and a GP in Loughborough, Leicestershire, said that the incident 'could have happened to many GPs'.

The inquiry also heard criticism against GSK ­ the company marketing fluticasone, as Flixotide ­ for 'exaggerating the relative safety' of the drug.

GSK said its literature reflected the best available evidence at the time. Sheriff Carol Kelly will give a verdict on the death within two months.

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