May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal axis, particularly in younger children or in patients receiving high doses for prolonged periods. Bronchospasm may occur with wheezing after inhalation. Avoid nasal corticosteroid use in recent nasal septal ulcers, nasal surgery or nasal trauma until healing has occurred. Prolonged use of corticosteroids may increase incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox should be avoided. Corticosteroids should not be used to treat ocular herpes simplex, cerebral malaria, or viral hepatitis. Prolonged treatment with corticosteroids associated with development of Kaposi’s sarcoma (case reports). Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Pre-existing psychiatric conditions may be exacerbated by corticosteroid use. Supplemental steroids (oral or parenteral) may be needed during stress or severe asthma attacks. Not to be used in status asthmaticus or for relief of acute bronchospasm. Use with caution in heart failure (fluid retention and hypertension with long-term use), in diabetes mellitus (may alter glucose production/regulation leading to hyperglycemia), in gastrointestinal diseases (diverticulitis, peptic ulcer, ulcerative colitis) due to perforation risk; in hepatic impairment, including cirrhosis (fluid retention with long-term use), and in myasthenia gravis (exacerbation of symptoms). Use with caution following acute myocardial infarct (myocardial rupture), in cataracts and/or glaucoma (increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use), in osteoporosis or risk for osteoporosis, in renal impairment (fluid retention may occur), and in history of seizure disorder (adrenal crisis). Changes in thyroid status (metabolic clearance of corticosteroids increases in hyperthyroidism and decreases in hypothyroidism). Orally-inhaled and intranasal corticosteroids may cause reduction in growth velocity in pediatric patients. There have been reports of systemic corticosteroid withdrawal symptoms (e.g. joint/muscle pain, lassitude, depression) when withdrawing inhalation therapy. When transferring to oral inhaler, previously-suppressed allergic conditions (rhinitis, conjunctivitis, eczema) may be unmasked.