[Treatment modalities and hypothalamo-pituitary-adrenal (HPA) axis suppression in Japanese patients with asthma].
We examined HPA axis function using a short tetracosactrin test in 94 asthmatics treated with three different modalities. The first group, (B + S), consisted of 41 patients taking BDP (910 +/- 320 micrograms, daily) plus a short term burst of oral steroids (20-40 mg daily, 3-7 days/course, 1-18 courses/year). The second group, (B + R), consisted of 19 patients taking BDP (1076 +/- 410 micrograms, daily) plus continuous oral steroids (2.5-20 mg/day for 1.8-24 years). The third group, (B alone), consisted of 34 patients taking BDP only (615 +/- 258 micrograms, daily). All patients had been inhaling BDP for more than 1 year. The rise in cortisol in response to tetracosactrin in B + S, B + R, and B alone was 12 +/- 4.3 micrograms/dl, 7.0 +/- 5.0 micrograms/dl and 14 +/- 4.5 micrograms/dl, respectively, and achieved cortisol was 21 +/- 4.5 micrograms/dl, 12 +/- 7.2 micrograms/dl and 23 +/- 4.2 micrograms/dl;, respectively. Both values were significantly lower in the B + R group than in either B + S or B alone. However, there was no difference between B + S and B alone, although the BDP dose was significantly larger in the B + S group. Significant HPA axis suppression (rise in cortisol < 7 micrograms/dl and achieved cortisol < 18 micrograms/dl) was seen in 7 patients. Although HPA axis suppression was more frequently seen in B + R (10/19), no significant difference was seen between B + S and B alone (4/41 and 1/34, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Hasegawa
T
T
Department of Respiratory Disease, Kobe City General Hospital.
Ishihara
K
K
Matsumoto
H
H
Tomioka
H
H
Okazaki
M
M
Katakami
N
N
Sakamoto
H
H
Umeda
B
B
Katayama
S
S
D000280:Administration, Inhalation; D000284:Administration, Oral; D000304:Adrenal Cortex Function Tests; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D001507:Beclomethasone / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*
D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D001507:Beclomethasone