Abstract
Studies of adrenal function were performed on 54 asthmatic patients who were taking long term high doses of inhaled beclomethasone dipropionate ranging from 500 to 2000 micrograms/day for between six and 60 months. Of the 43 patients taking up to 1500 micrograms/day, 39 (91%) had normal basal plasma cortisol concentrations and normal short tetracosactrin responses and 24 hour urinary free cortisol excretion was within the normal range in eight of nine patients tested. Some evidence of adrenal suppression was found in patients taking 2000 micrograms/day, with basal plasma cortisol below the normal range in four out of 11 patients and 24 hour urinary free cortisol excretion below the normal range in five out of six patients tested. Only one of the 11 patients taking 2000 micrograms/day had a short tetracosactrin response below the normal range: the mean rise in plasma cortisol was, however, significantly lower in this group than in those taking 1000 micrograms/day (328 (SE 30) and 506 (34) nmol/l respectively) (p less than 0.01). Patients taking more than 1500 micrograms/day of inhaled beclomethasone may require systemic corticosteroids during prolonged stress.
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- Costello J. F., Clark T. J. Response of patients receiving high dose beclomethasone dipropionate. Thorax. 1974 Sep;29(5):571–573. doi: 10.1136/thx.29.5.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gaddie J., Petrie G. R., Reid I. W., Skinner C., Sinclair D. J., Palmer K. N. Aerosol beclomethasone dipropionate: a dose-response study in chronic bronchial asthma. Lancet. 1973 Aug 11;2(7824):280–281. doi: 10.1016/s0140-6736(73)90788-5. [DOI] [PubMed] [Google Scholar]
- Harris D. M., Martin L. E., Harrison C., Jack D. The effect of oral and inhaled beclomethasone dipropionate on adrenal function. Clin Allergy. 1973 Sep;3(3):243–248. doi: 10.1111/j.1365-2222.1973.tb01329.x. [DOI] [PubMed] [Google Scholar]
- Harris D. M. Properties and therapeutic uses of some corticosteroids with enhanced topical potency. J Steroid Biochem. 1975 May;6(5):711–716. doi: 10.1016/0022-4731(75)90057-6. [DOI] [PubMed] [Google Scholar]
- Lindholm J., Kehlet H., Blichert-Toft M., Dinesen B., Riishede J. Reliability of the 30-minute ACTH test in assessing hypothalamic-pituitary-adrenal function. J Clin Endocrinol Metab. 1978 Aug;47(2):272–274. doi: 10.1210/jcem-47-2-272. [DOI] [PubMed] [Google Scholar]
- Melby J. C. Drug spotlight program: systemic corticosteroid therapy: pharmacology and endocrinologic considerations. Ann Intern Med. 1974 Oct;81(4):505–512. doi: 10.7326/0003-4819-81-4-505. [DOI] [PubMed] [Google Scholar]
- Smith M. J., Hodson M. E. High-dose beclomethasone inhaler in the treatment of asthma. Lancet. 1983 Feb 5;1(8319):265–269. doi: 10.1016/s0140-6736(83)91686-0. [DOI] [PubMed] [Google Scholar]
- Spitzer S. A., Kaufman H., Koplovitz A., Topilsky M., Blum I. Beclomethasone dipropionate and chronic asthma. The effect of long-term aerosol administration on the hypothalamic-pituitary-adrenal axis after substitution for oral therapy with corticosteroids. Chest. 1976 Jul;70(1):38–42. doi: 10.1378/chest.70.1.38. [DOI] [PubMed] [Google Scholar]
- Toogood J. H., Lefcoe N. M., Haines D. S., Jennings B., Errington N., Baksh L., Chuang L. A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma. J Allergy Clin Immunol. 1977 Apr;59(4):298–308. doi: 10.1016/0091-6749(77)90051-3. [DOI] [PubMed] [Google Scholar]
- Weinberger M., Sherman B. Inhaled steroid aerosols and alternate-day prednisone. Lancet. 1979 Apr 21;1(8121):871–872. doi: 10.1016/s0140-6736(79)91281-9. [DOI] [PubMed] [Google Scholar]