Adrenal function and high dose inhaled corticosteroids for asthma
Journal
Archives of Disease in Childhood
Date Issued
May 1997
DOI
10.1136/adc.76.5.405
Abstract
Objective—To investigate eVects on adrenal
function of fluticasone, a recently
released inhaled steroid preparation with
lower systemic bioavailability than beclomethasone
dipropionate.
Methods—34 children on high doses (400-
909 µg/m2
/d) of inhaled beclomethasone
dipropionate or budesonide were recruited
into a double blind, crossover
study investigating the eVects on adrenal
function of beclomethasone and fluticasone
propionate, given using a standard
spacer (Volumatic). The 24 hour excretion
rates of total cortisol and cortisol metabolites
were determined at baseline (after a
two week run in), after six weeks treatment
with an equal dose of beclomethasone,
and after six weeks of treatment with
half the dose of fluticasone, both given
through a spacer device.
Results—The comparison of eVects between
fluticasone and beclomethasone
during treatment periods, although favouring
fluticasone in all measured variables,
reached significance only after
correction for urinary creatinine excretion
(tetrahydrocortisol and 5á-tetrahydrocortisol
geometric means: 424 v 341
µg/m2
/d). The baseline data showed adrenal
suppression in the children taking
beclomethasone (total cortisol geometric
means: 975 v 1542 µg/d) and a dose related
suppression in the children taking budesonide.
Suppressed adrenal function in the
children who were taking beclomethasone
at baseline subsequently improved with
fluticasone and beclomethasone during
treatment periods.
Conclusions—Fluticasone is less likely to
suppress adrenal function than beclomethasone
at therapeutically equivalent
doses. The baseline data also support the
claim that spacer devices should be used
for the administration of high doses of
inhaled topical steroids
function of fluticasone, a recently
released inhaled steroid preparation with
lower systemic bioavailability than beclomethasone
dipropionate.
Methods—34 children on high doses (400-
909 µg/m2
/d) of inhaled beclomethasone
dipropionate or budesonide were recruited
into a double blind, crossover
study investigating the eVects on adrenal
function of beclomethasone and fluticasone
propionate, given using a standard
spacer (Volumatic). The 24 hour excretion
rates of total cortisol and cortisol metabolites
were determined at baseline (after a
two week run in), after six weeks treatment
with an equal dose of beclomethasone,
and after six weeks of treatment with
half the dose of fluticasone, both given
through a spacer device.
Results—The comparison of eVects between
fluticasone and beclomethasone
during treatment periods, although favouring
fluticasone in all measured variables,
reached significance only after
correction for urinary creatinine excretion
(tetrahydrocortisol and 5á-tetrahydrocortisol
geometric means: 424 v 341
µg/m2
/d). The baseline data showed adrenal
suppression in the children taking
beclomethasone (total cortisol geometric
means: 975 v 1542 µg/d) and a dose related
suppression in the children taking budesonide.
Suppressed adrenal function in the
children who were taking beclomethasone
at baseline subsequently improved with
fluticasone and beclomethasone during
treatment periods.
Conclusions—Fluticasone is less likely to
suppress adrenal function than beclomethasone
at therapeutically equivalent
doses. The baseline data also support the
claim that spacer devices should be used
for the administration of high doses of
inhaled topical steroids