title: Comparison of the effect of high-dose inhaled budesonide and fluticasone on adrenal function in patients with severe chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a leading cause of respiratory-related morbidity and mortality. Inhaled steroids are frequently used in patients with moderate to severe disease and may lead to adrenal suppression.
  
  
  OBJECTIVE
  The aim of this study was to compare the effect of inhaled budesonide/formoterol with inhaled fluticasone/salmeterol in severe COPD.
  
  
  METHODS
  It was a prospective open-label crossover study of 22 patients. Adrenal suppression was measured by overnight urinary cortisol/creatinine ratio. The measurements were taken while patients were on either combination for at least 4 weeks.
  
  
  RESULTS
  A total of 12 patients completed the study. The mean age was 64 years (8 males, 4 females). The mean FEV1 was 1 L (range, 0.5-1.8). There was no significant difference in adrenal suppression measured by overnight urinary cortisol/creatinine ratio (budesonide 5.2 ± 4.3, fluticasone 4.7 ± 3.1; 95% CI -2.2 to 1.2; P = 0.52) and urinary cortisol concentration (budesonide 51 ± 53, fluticasone 43 ± 31 [nmol/l]; 95% CI -35 to 20; P = 0.56).
  
  
  CONCLUSIONS
  Inhaled budesonide and fluticasone have no significantly different effect on adrenal function in moderate to severe COPD. The adverse event profile of high-dose inhaled steroids should not influence the choice of medication.
authors.affiliation: Division of Cardiovascular and Respiratory Studies, Department of Respiratory Medicine,Castle Hill Hospital, Cottingham, HU16 5JQ, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fahim
authors.forename: Shoaib
authors.initials: S
authors.lastname: Faruqi
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Wright
authors.forename: Jack A
authors.initials: JA
authors.lastname: Kastelik
authors.forename: Alyn H
authors.initials: AH
authors.lastname: Morice