Skin bruising, adrenal function and markers of bone metabolism in asthmatics using inhaled beclomethasone and fluticasone

Fluticasone propionate (FP) is generally considered to have twice the effic acy of beclomethasone dipropionate (BDP) on a weight-to-weight basis for th e control of asthma, and may have lesser effects on adrenal function. Howev er, the effects of FP and BDP on skin integrity and bone metabolism markers require further examination. Sixty-nine asthmatic subjects were enrolled in a double-blind crossover stu dy in which, after a baseline period, they received BDP or FP (at half the dose of BDP) for two 4-month periods each. A questionnaire on skin bruising , a skin examination, tests of adrenal function and of markers of bone meta bolism were performed after 2 months of each period. The number of asthma exacerbations was not significantly different for the two treatment periods (eight for BDP and nine for FP), nor were various ind ices of asthma control. Whereas the frequency of bruising reported by the q uestionnaire was not different, there were more bruises on examination for BDP (1.6+/-2.5) than for FP(1.2+/-2.3) (p=0.04), Although baseline serum co rtisol wits not significantly different for the two drugs, the increase in cortisol after cortrosyn was lower for BDP (357+/-158 mu mol.dL(-1)) than f or FP (422+/-144 mu mol.dL(-1)) (p<0.01). Serum osteocalcin levels were sig nificantly lower in subject on BDP (2.8+/-1.7 mu g.mL(-1)) than on FP (3.5/-1.9 ng.mL(-1)) (p=0.003). Other markers of bone metabolism were not signi ficantly altered. The three major side-effects were loosely, but significan tly correlated with the periods on BDP and FP, However, skin bruises, incre ase in cortisol after Cortrosyn and osteocalcin were not significantly corr elated for the period on either BDP or FP, In conclusion, whereas fluticasone propionate used at half the dose of becl omethasone dipropionate has a comparable effect an the control of asthma, f luticasone propionate demonstrated fewer side-effects in terms of skin brui sing, adrenal suppression and bone metabolism.