Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • Author FAQs
    • Open access
    • COVID-19 submission information
  • Alerts
  • Podcasts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • For authors
    • Instructions for authors
    • Submit a manuscript
    • Author FAQs
    • Open access
    • COVID-19 submission information
  • Alerts
  • Podcasts
  • Subscriptions

Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma

Ingrid Maijers, Nethmi Kearns, James Harper, Mark Weatherall, Richard Beasley
European Respiratory Journal 2020 55: 1901147; DOI: 10.1183/13993003.01147-2019
Ingrid Maijers
1Medical Research Institute of New Zealand, Wellington, New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nethmi Kearns
1Medical Research Institute of New Zealand, Wellington, New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Nethmi Kearns
James Harper
1Medical Research Institute of New Zealand, Wellington, New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for James Harper
Mark Weatherall
2Dept of Medicine, University of Otago Wellington, Wellington, New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Richard Beasley
1Medical Research Institute of New Zealand, Wellington, New Zealand
3School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Richard Beasley
  • For correspondence: richard.beasley@mrinz.ac.nz
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background The proportion of the efficacy of high-dose inhaled corticosteroids (ICS) in oral corticosteroid-dependent asthma that is due to systemic effects is uncertain. This study aimed to estimate the ICS dose–response relationship for oral corticosteroid-sparing effects in oral corticosteroid-dependent asthma, and to determine the proportion of oral corticosteroid-sparing effects due to their systemic effects, based on the comparative dose–response relationship of ICS versus oral corticosteroids on adrenal suppression.

Methods Systematic review and meta-analysis of randomised controlled trials reporting oral corticosteroid-sparing effects of high-dose ICS in oral corticosteroid-dependent asthma. In addition, reports of oral corticosteroid to ICS dose-equivalence in terms of adrenal suppression were retrieved. The primary outcome was the proportion of the oral corticosteroid-sparing effect of ICS that could be attributed to systemic absorption, per 1000 µg increase of ICS, expressed as a ratio. This ratio estimates the oral corticosteroid sparing effect of ICS due to systemic effects.

Results 11 studies including 1283 participants reporting oral corticosteroid-sparing effects of ICS were identified. The prednisone dose decrease per 1000 µg increase in ICS varied from 2.1 mg to 4.9 mg, depending on the type of ICS. The ratio of the prednisone-sparing effect due to the systemic effects per 1000 µg of fluticasone propionate was 1.02 (95% CI 0.68–2.08) and for budesonide was 0.93 (95% CI 0.63–1.89).

Conclusion In patients with oral corticosteroid-dependent asthma, the limited available evidence suggests that the majority of the oral corticosteroid-sparing effect of high-dose ICS is likely to be due to systemic effects.

Abstract

In oral corticosteroid-dependent asthma, the majority of the oral corticosteroid-sparing effects of high-dose inhaled corticosteroids (ICS) are due to their systemic effects. Clinicians should be aware of this bioequivalence when prescribing high-dose ICS. http://bit.ly/2m0Fa8m

Footnotes

  • This review and meta-analysis is registered with PROSPERO (registration number: CRD42019119674).

  • Conflict of interest: I. Maijers has nothing to disclose.

  • Conflict of interest: N. Kearns has nothing to disclose.

  • Conflict of interest: J. Harper has nothing to disclose.

  • Conflict of interest: M. Weatherall has nothing to disclose.

  • Conflict of interest: R. Beasley reports grants from Health Research Council of New Zealand, during the conduct of the study; grants and personal fees for lectures and advisory board work, and travel expenses to attend meetings from AstraZeneca, grants from GlaxoSmithKline and Genentech, personal fees for advisory board work and travel expenses to attend meetings from Theravance Biopharma, outside the submitted work.

  • Support statement: The MRINZ is supported by Independent Research Organisation funding by the Health Research Council of New Zealand. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received June 12, 2019.
  • Accepted September 16, 2019.
  • Copyright ©ERS 2020
https://www.ersjournals.com/user-licence
View Full Text

ERS Members

myERS - ERS members : log in with your myERS username and password.

INDIVIDUALS

Log in Login as an individual user.

Forgot your username or password?

LIBRARY USERS

Log in through your institution

If your library has a subscription, you may already be logged in via your IP address. Otherwise you may be able to log in via one of the following routes.
You may be able to gain access using your login credentials for your institution. Contact your library if you do not have a username and password.
If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.
If you think you should have access, please contact your librarian or email journals@ersnet.org

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.
PreviousNext
Back to top
View this article with LENS
Vol 55 Issue 1 Table of Contents
European Respiratory Journal: 55 (1)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma
Ingrid Maijers, Nethmi Kearns, James Harper, Mark Weatherall, Richard Beasley
European Respiratory Journal Jan 2020, 55 (1) 1901147; DOI: 10.1183/13993003.01147-2019

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma
Ingrid Maijers, Nethmi Kearns, James Harper, Mark Weatherall, Richard Beasley
European Respiratory Journal Jan 2020, 55 (1) 1901147; DOI: 10.1183/13993003.01147-2019
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Shareable PDF
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Original Articles

  • EmPHasis-10 health-related quality of life score predicts outcomes in PAH
  • EmPHasis-10 as a measure of quality of life in PAH
  • Periostin and airway epithelial function in asthma
Show more Original Articles

Asthma

  • Cost-effectiveness of azithromycin in reducing asthma exacerbations
  • Complement C3 and allergic asthma
  • OSTEOPOROSIS AND FRAGILITY FRACTURES IN ASTHMA
Show more Asthma

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Reviewers
  • CME
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Submit a manuscript
  • ERS author centre

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2021 by the European Respiratory Society