Adrenal suppression may be a concern in some patients with asthma who use inhaled corticosteroids. A study published in Thorax (1993; Volume 48:599–602) examined adrenal function in children receiving inhaled steroid therapy. The study included 49 children with a mean age of 9.2 years who were taking budesonide (400 micrograms per day) and 28 children with a mean age of 10.2 years taking beclomethasone dipropionate at the same dose. These groups were compared with 23 non-asthmatic children with a mean age of 8.9 years. Cortisol concentrations were significantly lower in the children using inhaled steroids compared with the non-asthmatic control group.
Additional research published in the Annals of Allergy, Asthma & Immunology (March 1996; Volume 76:234–238) evaluated adrenal effects in 39 patients with asthma using beclomethasone dipropionate. Of these, 24 patients used a metered-dose inhaler (MDI) with a spacer, while 15 patients used the inhaler directly. A spacer is an attachment designed to improve coordination between inhalation and actuation, enhance drug delivery to the lungs, and reduce systemic absorption. The study found evidence of adrenal suppression—measured by low 24-hour urinary free cortisol excretion—in 47% of patients using the inhaler without a spacer, compared with 8% of those using a spacer.
Further concern was raised in a report published in the Journal of Allergy and Clinical Immunology (1998; Volume 102:699–700), which reviewed four cases of patients treated with fluticasone propionate. All patients showed clinical or laboratory evidence of adrenal suppression.
Taken together, these findings suggest that inhaled glucocorticoids, while effective for asthma management, may be associated with adrenal suppression in some patients—particularly depending on dose, delivery method, and individual susceptibility.
