Effects of High-Dose Inhaled Corticosteroids on Plasma Cortisol Concentrations in Healthy Adults

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Abstract
INHALED corticosteroid (ICS) preparations have become widely accepted as first-line treatment for persistent symptoms of bronchial asthma.1 As physicians have increasingly prescribed corticosteroid aerosols in higher doses, there have also been growing concerns regarding possible systemic effects. Short-term clinical studies performed in healthy volunteers and subjects with asthma have demonstrated that high doses of ICS may affect hypothalamic-pituitary-adrenal (HPA) axis function,2 bone density,3 bone metabolism,4 collagen synthesis in the skin,5 and skin thickness.6 In clinical trials of ICS agents, single morning plasma cortisol determinations are often the principal test used to assess the presence of systemic effects.2 While single morning samples frequently yield normal results across a wide range of ICS doses, measurement of cortisol production throughout an entire day has been found to be much more sensitive in detecting systemic effects and may demonstrate cortisol suppression after brief periods of treatment with corticosteroids.7-10