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Adrenal suppression in bronchiectasis and the impact of inhaled corticosteroids

¹ Lung Investigation Unit, ³ Dept of Biochemistry, University Hospital Birmingham NHS Foundation Trust, and ² Dept of Endocrinology, Division of Medical Sciences, University of Birmingham, Birmingham, UK.

CORRESPONDENCE: R. A. Stockley, Lung Investigation Unit, 1st Floor Nuffield House, Queen Elizabeth Hospital, Birmingham, B1 1TW, UK. Fax: 44 1216978257. E-mail: rob.stockley{at}uhb.nhs.uk

Keywords: Adrenal insufficiency, bronchiectasism, glucocorticoids, inhaled corticosteroid, short synacthen test

Received: February 4, 2008
Accepted May 9, 2008

The present study identified three patients with bronchiectasis receiving inhaled corticosteroids (ICSs) who had symptomatic adrenal suppression secondary to ICS. The prevalence of adrenal suppression is unknown in bronchiectasis. The frequency of adrenal suppression and the impact of ICS use in bronchiectasis patients were examined.

In total, 50 outpatients (33 receiving ICSs) underwent a short Synacthen test and completed a St George’s Respiratory Questionnaire (SGRQ). Symptoms of adrenal suppression, steroid use and lung function were compared between subjects who were suppressed and those who were not.

Adrenal suppression was evident in 23.5% of subjects who did not receive ICSs and 48.5% of those who did. Basal cortisol and the increments by which cortisol increased 30 min after Synacthen were lower in suppressed than in nonsuppressed subjects. The incremental cortisol rise was negatively correlated with SGRQ impacts and total score, suggesting a worse quality of life in those who had an impaired adrenal response. The greatest frequency of generalised symptoms was seen in the suppressed group.

A significant proportion of subjects with bronchiectasis have evidence of adrenal suppression, and this is increased when inhaled corticosteroids are also used. Impairment of the cortisol response to stimulation is associated with poorer health status.