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Related Experiment Videos

Adrenal function and high dose inhaled corticosteroids for asthma

P K Yiallouros1, A D Milner, E Conway

  • 1Children's Respiratory Unit, United Medical School of Guy's Hospital, University of London.

Archives of Disease in Childhood
|May 1, 1997
PubMed
Summary

Fluticasone, an inhaled steroid, shows less adrenal suppression than beclomethasone in children. Using spacer devices is recommended for high-dose inhaled steroid administration.

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Area of Science:

  • Pediatric Endocrinology
  • Pharmacology
  • Respiratory Medicine

Background:

  • Inhaled corticosteroids (ICS) are widely used for pediatric asthma management.
  • Concerns exist regarding the potential for systemic absorption and adrenal suppression with high-dose ICS therapy.
  • Fluticasone propionate offers lower systemic bioavailability compared to older ICS like beclomethasone dipropionate.

Purpose of the Study:

  • To compare the effects of fluticasone propionate and beclomethasone dipropionate on adrenal function in children receiving high-dose ICS.
  • To evaluate the efficacy of spacer devices in mitigating adrenal suppression from ICS.

Main Methods:

  • A double-blind, crossover study involving 34 children on high-dose ICS (beclomethasone or budesonide).
  • Participants received beclomethasone and fluticasone propionate via a spacer device (Volumatic) for six weeks each.

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  • 24-hour urinary excretion of total cortisol and metabolites was measured at baseline and during treatment periods.

    • Main Results:

    • Fluticasone propionate demonstrated a trend towards less adrenal suppression compared to beclomethasone dipropionate, reaching statistical significance after creatinine correction.
    • Baseline adrenal suppression was observed in children on beclomethasone and dose-related suppression with budesonide.
    • Adrenal function improved during treatment periods for children with baseline suppression.

    Conclusions:

    • Fluticasone propionate is associated with a lower risk of adrenal suppression than beclomethasone dipropionate at equivalent therapeutic doses.
    • The use of spacer devices is crucial for administering high-dose inhaled topical steroids to minimize systemic absorption and adrenal effects.