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a Children's Respiratory Unit,
Division of Paediatrics, United Medical and Dental Schools of Guy's
and St Thomas' Hospitals, University of London, London, b Department of Chemical
Pathology, University College London Hospitals, London
Correspondence to: Professor AD Milner, Department of Paediatrics, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH.
Accepted 31
January 1997
OBJECTIVE
To investigate effects on adrenal
function of fluticasone, a recently released inhaled steroid
preparation with lower systemic bioavailability than beclomethasone dipropionate.
METHODS34 children on high doses (400-909 µg/m2/d) of inhaled beclomethasone dipropionate or
budesonide were recruited into a double blind, crossover study
investigating the effects on adrenal function of beclomethasone and
fluticasone propionate, given using a standard spacer (Volumatic). The
24 hour excretion rates of total cortisol and cortisol metabolites were
determined at baseline (after a two week run in), after six weeks
treatment with an equal dose of beclomethasone, and after six weeks of
treatment with half the dose of fluticasone, both given through a
spacer device.
RESULTSThe comparison of effects between
fluticasone and beclomethasone during treatment periods, although
favouring fluticasone in all measured variables, reached significance
only after correction for urinary creatinine excretion
(tetrahydrocortisol and 5
-tetrahydrocortisol geometric means:
424 v 341 µg/m2/d). The baseline data showed
adrenal suppression in the children taking beclomethasone (total
cortisol geometric means: 975 v 1542 µg/d) and a dose
related suppression in the children taking budesonide. Suppressed
adrenal function in the children who were taking beclomethasone at
baseline subsequently improved with fluticasone and beclomethasone during treatment periods.
CONCLUSIONSFluticasone is less likely to
suppress adrenal function than beclomethasone at therapeutically
equivalent doses. The baseline data also support the claim that spacer
devices should be used for the administration of high doses of inhaled
topical steroids.
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