Abstract
Large spacing devices have been shown to provide more selective delivery of an inhaled steroid to the lung but the effect on the hypothalamo-pituitary-adrenal suppression associated with high dose inhaled corticosteroids has been little studied. The effect of a large spacing device (Volumatic; 750 ml) on suppression of 0900 h cortisol after 2 mg inhaled beclomethasone dipropionate was therefore investigated in normal, healthy volunteers. Twenty four subjects (12 male, 12 female) took part in a randomised, double blind, placebo controlled cross over study in which a single dose of 2 mg beclomethasone dipropionate was taken at 2300 h on two occasions seven days apart, once from a metered dose inhaler alone and once from a metered dose inhaler attached to a 750 ml spacing device. The 0900 h serum cortisol concentration was the same on the morning before each administration (468 nmol/l, 95% confidence interval (CI) 390-561 nmol/l, day 1 v 479 nmol/l, 95% CI 463-494 nmol/l, day 8). The 0900 h serum cortisol concentration the following morning, however, was lower when 2 mg beclomethasone dipropionate was given by metered dose inhaler alone (182 (95% CI 128-264) nmol/l) than when it was given by a spacing device (363 (95% CI 281-475) nmol/l). These results suggest that a large spacing device attached to a metered dose inhaler may decrease the risk of hypothalamo-pituitary-adrenal suppression by high dose inhaled steroid treatment.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ebden P., Jenkins A., Houston G., Davies B. H. Comparison of two high dose corticosteroid aerosol treatments, beclomethasone dipropionate (1500 micrograms/day) and budesonide (1600 micrograms/day), for chronic asthma. Thorax. 1986 Nov;41(11):869–874. doi: 10.1136/thx.41.11.869. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gordon A. C., McDonald C. F., Thomson S. A., Frame M. H., Pottage A., Crompton G. K. Dose of inhaled budesonide required to produce clinical suppression of plasma cortisol. Eur J Respir Dis. 1987 Jul;71(1):10–14. [PubMed] [Google Scholar]
- Martin L. E., Tanner R. J., Clark T. J., Cochrane G. M. Absorption and metabolism of orally administered beclomethsone dipropionate. Clin Pharmacol Ther. 1974 Mar;15(3):267–275. doi: 10.1002/cpt1974153267. [DOI] [PubMed] [Google Scholar]
- Newman S. P., Morén F., Pavia D., Little F., Clarke S. W. Deposition of pressurized suspension aerosols inhaled through extension devices. Am Rev Respir Dis. 1981 Sep;124(3):317–320. doi: 10.1164/arrd.1981.124.3.317. [DOI] [PubMed] [Google Scholar]
- Prahl P., Jensen T. Decreased adreno-cortical suppression utilizing the Nebuhaler for inhalation of steroid aerosols. Clin Allergy. 1987 Sep;17(5):393–398. doi: 10.1111/j.1365-2222.1987.tb02031.x. [DOI] [PubMed] [Google Scholar]
- Smith M. J., Hodson M. E. Effects of long term inhaled high dose beclomethasone dipropionate on adrenal function. Thorax. 1983 Sep;38(9):676–681. doi: 10.1136/thx.38.9.676. [DOI] [PMC free article] [PubMed] [Google Scholar]