title: Switching from systemic steroids to ciclesonide restores the hypothalamic pituitary-adrenal axis.
abstract: BACKGROUND
  Treatment of difficult asthma with oral corticosteroids (OCS) may suppress the hypothalamic-pituitary-adrenal axis.
  
  
  OBJECTIVE
  In this study we have checked if the substitution of OCS with very high doses of ciclesonide may restore the adrenal function without losing the control of the disease.
  
  
  METHODS
  In 5 patients with difficult, uncontrolled asthma despite treatment with OCS, inhaled and systemic glucocorticosteroids were replaced with very high doses of ciclesonide (1600-2400 µg/day). The symptoms of asthma and the lung function were assessed at baseline and on the 28(th), 56(th) and 70(th) day of treatment, whereas the levels of cortisol and adrenocorticotropic hormone (ACTH) in the morning were measured at baseline and on the 28(th) and the 56(th) day of treatment.
  
  
  RESULTS
  In all patients, the control of asthma symptoms, measured with Asthma Control Test questionnaire, improved from the mean score of 9.4 to 19.8 in 70 days. In 4 subjects force expiratory volume in 1 s improved gradually through the entire study reaching a mean improvement of 585 ml in 70 days. The ACTH levels were normalized in 3 patients after 28 days of observation and in all patients after 56 days. The cortisol level was normalized in 4 patients after 28 days and in another subject after 56 days of treatment with ciclesonide.
  
  
  CONCLUSIONS
  Switching from prednisone to very high doses of ciclesonide normalized the hypothalamic-pituitary adrenal axis function and also improved the disease control and the lung function in these 5 patients with difficult asthma.
authors.affiliation: Department of Pneumonology and Allergy, Medical University of Lodz, Poland. Head of Department: Prof. Paweł Górski MD, PhD.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Marczak
authors.affiliation: Department of General and Oncological Pneumonology, Medical University of Lodz, Poland. Head of Department: Prof. Adam Antczak MD, PhD.
authors.forename: Maciej
authors.initials: M
authors.lastname: Ciebiada
authors.affiliation: Department of Pneumonology and Allergy, Medical University of Lodz, Poland. Head of Department: Prof. Paweł Górski MD, PhD.
authors.forename: Paweł
authors.initials: P
authors.lastname: Górski
keywords: adrenal function; ciclesonide; corticosteroids; severe asthma; therapy
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