A cross‐sectional study evaluating the relationship between cortisol suppression and asthma control in patients with difficult asthma

Abstract

AimTo examine the relationship between cortisol suppression and asthma symptoms in patients with difficult asthma. MethodsPatients, referred to a specialist difficult asthma service and who fulfilled the criteria for difficult asthma, were recruited to the study in a sequential, unselected manner. At each clinic visit, all patients completed a validated asthma control questionnaire. For measuring cortisol suppression, early morning urinary cortisol [corrected for creatinine to give urinary cortisol creatinine ratio (UCC ratio)] was used. The urine samples were collected and stored at − 70 ° C until ready for analysis. Urinary cortisol was extracted (solid-phase extraction) and analysed using high-per formance liquid chromatography. The Pearson correlation coefficient was used for correlation analysis while t -tests were used for between-group differences for normally distributed data. If the data were not normally distributed, nonparametric statistics were used. A Pvalue < 0.05 was considered statistically significant. ResultsDuring the study period all the patients who attended the difficult asthma clinic and fulfilled the criteria for difficult asthma ( n = 66) agreed to take part in the study. There were moderate to strong and significant associations between several measures of asthma control and UCC ratio. The correlation coefficient with five indicators of asthma control ranged between 0.3 and 0.5 ( P < 0.05). ConclusionsWe have demonstrated a relationship between cortisol suppression and asthma control in difficult asthmatics on high-dose steroid therapy. We have proposed a model based on the relationship between symptom control and cor tisol suppression, whereby both adherence and therapeutic adjustments could potentially be made. A properly controlled prospective clinical trial should examine the utility of this approach in clinical practice.

Metabolomic profiling reveals extensive adrenal suppression due to inhaled corticosteroid therapy in asthma

“…Second, we observed that this reduction in steroids was primarily, but not exclusively driven by ICS use in asthmatics, suggesting that the reduced steroid levels represent both a fundamental characteristic of the asthma phenotype and a result of ICS use. Third, not only were cortisol levels consistently reduced among asthmatics on ICS compared with all other groups throughout an entire 24-hour diurnal period, but this group had the largest variation in levels throughout the day, with a steep reduction in cortisol levels during the early morning hours, a peak time for asthma exacerbations to occur 31,32 Prior studies have correlated low cortisol with decreased asthma control 35 , suggesting that this reduction may pose a further threat during this vulnerable time 31,32 . The global reduction in cortisol levels was so pronounced that on average, peak cortisol levels among asthmatics on ICS during an entire 24-hour period, were lower than the average minimum cortisol levels among any of the other groups at any time.…”

Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review

“…Exogenous corticosteroids have an adrenal suppressive effect, 16,45 and cortisol level was reported in several studies as a surrogate for adherence to oral corticosteroids, 9,16,17,27,28,30 although using varied and non-validated cut-offs. Many factors can influence cortisol levels, such as circadian rhythm, ICS use and the variability of cortisol values between individuals, 46,47 and so (as for prednisolone levels above) studies are required to validate timings and cutoffs to support their clinical use in patients with severe asthma.…”

Medication adherence in asthma patients

“…suppression in patients who are taking oral corticosteroids [4] and measurement of urine cortisol: creatinine ratio in patients who are on high-dose inhaled corticosteroids [5]. suppression in patients who are taking oral corticosteroids [4] and measurement of urine cortisol: creatinine ratio in patients who are on high-dose inhaled corticosteroids [5].…”