Adrenal suppression in bronchiectasis and the impact of inhaled corticosteroids

¹ Lung Investigation Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, U.K.; and Division of Medical Sciences, University of Birmingham, U.K.
² Division of Medical Sciences, University of Birmingham, U.K.
³ Dept of Biochemistry, University Hospital Birmingham NHS Foundation Trust, Birmingham, U.K.
⁴ Lung Investigation Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, U.K.

^* To whom correspondence should be addressed. E-mail: rob.stockley{at}uhb.nhs.uk.

	Abstract

We identified 3 patients with bronchiectasis receiving inhaled corticosteroid (ICS) who had symptomatic adrenal suppression secondary to ICS. The prevalence of adrenal suppression is unknown in bronchiectasis. We examined the frequency of adrenal suppression and the impact of ICS use in bronchiectasis patients.

50 outpatients (33 receiving ICS) underwent a short synacthen test, and completed a St Georges 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 these who did not and 48.5% (p=0.043) of those who did receive ICS. Basal cortisol and the increments by which cortisol increased 30 minutes after synacthen were lower in suppressed compared with non-suppressed 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 ICS is also used. Impairment of the cortisol response to stimulation is associated with worse health status.