Inhaled fluticasone and adrenal effects in adult asthma: systematic review & meta-analysis

¹ Medical Research Institute of New Zealand, Wellington, New Zealand
² Wellington School of Medicine & Health Sciences, Wellington, New Zealand
³ P3 Research, Wellington, New Zealand
⁴ Medical Research Institute of New Zealand, Wellington, New Zealand; and University of Southampton, Southampton, United Kingdom

^* To whom correspondence should be addressed. E-mail: Richard.Beasley{at}mrinz.ac.nz.

	Abstract

To determine the dose-response relationship of inhaled fluticasone propionate (FP) for adrenal suppression in adults with asthma.

Systematic review and meta-analysis of placebo-controlled randomised dose-response studies of at least four weeks duration that assessed the adrenal effects of FP by cosyntropin stimulation tests in adult asthma. The main outcome measure was the proportion of subjects with adrenal function below the lower limit of the normal range.

Five studies with 732 subjects with asthma met the inclusion criteria. Data on daily doses >1000 µg were limited to one study. The proportion of subjects with adrenal function below the lower limit of the normal range on placebo was 3.9%; for a 500 µg per day increase in FP dose the odds of an abnormality increased by 1.38 (95% CI 1.01 to 1.59). The continuous secondary outcome measures showed an inverse linear relationship with the FP dose up to 2000 µg per day.

We conclude that for routine prescribing within the established therapeutic dose-response range (50 to 500 µg per day), FP has minimal effects on adrenal function. This conclusion is limited by the paucity of long term studies of daily doses of FP >1000 µg and the considerable individual variability in the response.