Inhaled fluticasone propionate and adrenal effects in adult asthma: systematic review and meta-analysis

Abstract

The dose-response relationship of inhaled fluticasone propionate (FP) for adrenal suppression in adults with asthma is not clear.The current authors carried out a systematic review and meta-analysis of placebo-controlled randomised dose-response studies of o4 weeks' duration, which assessed the adrenal effects of FP by cosyntropin stimulation tests in adult asthma. The main outcome measure was the proportion of subjects with adrenal function below the lower limit of the normal range.Five studies, with a total of 732 subjects with asthma, met the inclusion criteria. Data on daily doses .1,000 mg were limited to one study. The proportion of subjects with adrenal function below the lower limit of the normal range on placebo was 3.9%; for a 500-mg per day increase in FP dose the odds of an abnormality increased by 1.38 (95% confidence interval 1.01-1.59). The continuous secondary outcome measures showed an inverse linear relationship with the FP dose up to 2,000 mg?day -1 .In conclusion, for routine prescribing within the established therapeutic dose-response range (50-500 mg?day -1 ), fluticasone propionate has minimal effects on adrenal function. This conclusion is limited by the paucity of long-term studies of daily doses of fluticasone propionate .1,000 mg and by the considerable individual variability in the response.

Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis

“…This is the first meta-analysis providing a broad view on the risk of adrenal insufficiency after use of various types of corticosteroids for several diseases. To the best of our knowledge, only one meta-analysis (88) has been published on appropriately tested adrenal insufficiency in asthma, reporting percentages of adrenal insufficiency ranging from 5.5% to 13.3%. In the current meta-analysis, we found a percentage of 6.8% of adrenal insufficiency in asthmatic patients using inhaled corticosteroids, which is in line with results from the meta-analysis mentioned.…”

Primary hypercortisolism and phaeochromocytoma next to, but not related to, each other

“…However, if that were true, the combination of hypercortisolism and catecholamine excess would have been observed and reported more often 11. The inhalational corticosteroids were considered unlikely to affect pituitary ACTH secretion and systemic hypercortisolism because this has only been reported from daily dosages of 500 μg or higher, while our patient used at most 200 μg per day 12. This is further accentuated by the postsurgical rise in ACTH and normalisation of cortisol levels while continuing the same medication after resection.…”

The Wrath of Steroids in Elderly Patients with Pulmonary Diseases

“…ICS have been demonstrated to suppress endogenous cortisol levels [75] and affect dynamic adrenal stimulation tests [76,77]. This effect may be more pronounced with fluticasone compared to other ICS [78].…”