We compared the systemic and clinical effects of ciclesonide (CIC) and fluticasone propionate (FP) administered, in addition to CIC 160 mg?day -1 and salmeterol 50 mg twice daily, in 32 patients with persistent asthma using a randomised double-blind, placebo-controlled, doubledummy, five-period crossover design. All patients exhibited a provocative concentration leading to a 20% decrease in forced expiratory volume in 1 s (PC20) methacholine ,8 mg?mL -1 and a PC20 adenosine ,60 mg?mL -1 . Primary outcome was 24-h serum cortisol suppression after 7 days. Secondary outcomes were changes in PC20 methacholine and adenosine after 9 days.FP 500 mg?day : -38.8 (95% CI -75.7--1.9) nmol?L -1 ). Compared with placebo, the increase in PC20 adenosine after the four treatments was small, but significant. Greater improvements in PC20 adenosine were seen with FP 500 mg?day . For a similar decrease in hyperresponsiveness, cortisol secretion was suppressed significantly with moderate-to-high doses of fluticasone propionate, but not with ciclesonide.

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