PURPOSE: Inhaled corticosteroids (ICS) are the mainstay of asthma therapy now- a- days. The potential for long-term adverse effects from ICS relates to their systemic absorption. With increasing use of ICS, there is always some risk of systemic absorption of these drugs.
METHODS: We compared the risk of adrenal suppression in 24 stable asthmatic adults of mean age 31.2 years with forced expiratory volume in one second (FEV1) 86% predicted and mid expiratory flow (FEF 25–75) 57.8% predicted, receiving inhaled budesonide and fluticasone propionate in doses of > 1500 to 2000 micrograms by metered dose inhaler in a double blind, placebo controlled design. Overnight urinary cortisol levels were measured at baseline, 4 week and 12 week intervals along with clinical and spirometric monitoring.
RESULTS: The mean overnight urinary cortisol level (n mol/12 hour) were: budesonide group-baseline (26.1), 4 week (21.3), 12 week (18.6), whereas fluticasone propionate group- baseline (26.3), 4 week (15.7) and 12 week (19.8) compared with placebo group- baseline (26.5), 4 week (26.8) and 12 week (26.3). One patient each receiving budesonide and fluticasone propionate developed clinical symptoms i.e. giddiness, fatigue, fall down and hypo tension during study period without any other obvious reason. Equal improvement was found in spirometric parameters in both drug groups.
CONCLUSION: Adrenal suppression is not uncommon with chronic high dose ICS therapy. This is more marked with fluticasone propionate especially during early phase of treatment, however, in long-term treatment, budesonide may cause more adrenal suppression. Such event during long-term high dose ICS therapy may prove clinically significant at the time of stress where it may produce acute adrenal crisis.
CLINICAL IMPLICATIONS: Patients receiving high dose ICS therapy should be educated regarding possible risk of adrenal suppression and systemic side effects while taking unsupervised therapy.
DISCLOSURE: Dr.Ramakant Dixit, No Financial Disclosure Information; No Product/Research Disclosure Information