Dr. Amy Nett: This a little bit tricky. Of course, remember that corticosteroids increase the risk of gastric ulcers. If a patient is doing an inhaled corticosteroid, there is a very, very small risk of ulcers very, very rarely. It seems that if the patients using an inhaler that contains a spacer device, it reduces the risk of gastritis, ulcers, and bleeding. If your patient is taking an inhaled steroid with a spacer device, it’s a very, very small risk, and you are probably safe using betaine HCl. I think it’s a mild relative contraindication. I say relative contraindication meaning, pause think about it, talk to the patient about it, but it’s not an absolute contraindication. If they’re using an inhaler and it does not have a spacer device, you can easily change that prescription. Inhaled corticosteroids, of course, you’re going to have more risk in terms of like mouth ulcers, not as much as going to get down to the stomach, but it’s not a zero probability. Even inhaled corticosteroids have a very, very small risk of gastric ulcers, gastritis, and bleeding. It’s a risk-benefit analysis. How often is the patient using inhaled corticosteroids? Hopefully, you’re working on getting them off because inhaled corticosteroids absolutely can affect each HPA axis as well, so most of us are trying to get our patients off inhaled corticosteroids anyway. But, risk-benefit analysis, see how much they need the HCl and when are they going to be able to get off inhaled corticosteroids. If you feel they absolutely need both HDL and corticosteroids, then at least make sure they’re using an inhaler device.