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Fears over child steroid doses prompt new NHS warning

NHS prescribing advisers have issued a fresh warning over maximum doses of inhaled steroids in children amid fears of poor prescribing.

Recent research has indicated high-dose steroids are often prescribed to children with asthma without appropriate add-on therapy or monitoring – despite the risks of adrenal suppression or even death.

In children under five, doses should not exceed 400mcg/day beclometasone dipropionate or equivalent, the National Prescribing Centre stressed in a new bulletin.

In those aged five to 12, this can rise to 800 if asthma is uncontrolled at lower doses. But the centre warned: 'Higher, unlicensed doses of steroids should only be initiated by specialists.'It follow concerns that some children are inappropriately given very high doses of inhaled steroids, often without trials of add-on therapy or the issue of steroid cards.

Dr Dermot Ryan, a GP in Loughborough and a member of the General Practice Airways Group, said: 'If children require high doses you need to confirm the diagnosis of asthma, that the child can use their inhaler and that they are compliant with medication.

'With a simple, structured approach the vast majority will not require more than 400mcg.'

Last year a study by Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, found 10 per cent of five to 11-year-olds with asthma were on high doses and only half on add-on therapies. Dr Thomas, also a member of the group, said: 'It's important all children on high doses are carefully reviewed and every effort made to reduce doses.'

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