TY - JOUR T1 - Effects of ciclesonide and fluticasone on cortisol secretion in patients with persistent asthma JF - European Respiratory Journal JO - Eur Respir J SP - 1277 LP - 1286 DO - 10.1183/09031936.00079908 VL - 33 IS - 6 AU - E. Derom AU - R. Louis AU - C. Tiesler AU - R. Engelstätter AU - J-M. Kaufman AU - G. F. Joos Y1 - 2009/06/01 UR - http://erj.ersjournals.com/content/33/6/1277.abstract N2 - We compared the systemic and clinical effects of ciclesonide (CIC) and fluticasone propionate (FP) administered, in addition to CIC 160 µg·day−1 and salmeterol 50 µg twice daily, in 32 patients with persistent asthma using a randomised double-blind, placebo-controlled, double-dummy, five-period crossover design. All patients exhibited a provocative concentration leading to a 20% decrease in forced expiratory volume in 1 s (PC20) methacholine <8 mg·mL−1 and a PC20 adenosine <60 mg·mL−1. Primary outcome was 24-h serum cortisol suppression after 7 days. Secondary outcomes were changes in PC20 methacholine and adenosine after 9 days. FP 500 µg·day−1 and 1,000 µg·day−1 significantly suppressed cortisol secretion versus placebo by -46.2 (95% confidence interval (CI) -83.8– -8.5) nmol·L−1 and by -76.1 (95% CI -112.9– -39.3) nmol·L−1, respectively. Neither dose of CIC (320 nor 640 µg·day−1) had a significant suppressive effect (-28.2 (95% CI -65.5–9.2) nmol·L−1 and -37.3 (95% CI -74.7–0.0) nmol·L−1, respectively). Differences between FP 1,000 µg·day−1 and both CIC treatments were statistically significant (CIC 320 µg·day−1: -48.0 (95% CI -84.8– -11.1) nmol·L−1; CIC 640 µg·day−1: -38.8 (95% CI -75.7– -1.9) nmol·L−1). Compared with placebo, the increase in PC20 adenosine after the four treatments was small, but significant. Greater improvements in PC20 adenosine were seen with FP 500 µg·day−1 (1.8 (95% CI 1.0–2.6) doubling concentrations) compared with CIC 320 μg·day−1 (0.9 (95% CI 0.1–1.7) doubling concentrations). No significant difference was seen between CIC 640 μg·day−1 and FP 1,000 μg·day−1. For a similar decrease in hyperresponsiveness, cortisol secretion was suppressed significantly with moderate-to-high doses of fluticasone propionate, but not with ciclesonide. ER -