Systemic effects of inhaled fluticasone propionate and budesonide in adultpatients with asthma

We assessed the systemic effects of budesonide (BUD) and fluticasone propio nate (FP) in 23 patients with asthma, using a double-blind, placebo-control led, double-dummy, and cross-over design. The following five treatments wer e given in a randomized order for 1 wk with a washout period in between of 2 wk: (7) placebo; (2) FP, 200 mu g twice a day, inhaled from a Diskhaler; (3) FP, 1,000 mu g twice a day, inhaled from a Diskhaler; (4) BUD, 200 mu g twice a day, inhaled from a Turbuhaler; and (5) BUD, 800 mu g twice a day, inhaled from a Turbuhaler. The primary variable was the area under the cur ve of serum cortisol versus time (AUC(0-20)), derived from serum samples ta ken every 2 h over a 20-h period following the last evening dose at 10:00 P .M. The lower doses of BUD and FLU did not cause any adrenal suppression. C ompared with placebo, however, FP (1,000 mu g, twice daily and BUD (800 mu g, twice daily) decreased the AUC(0-20) by 34 and 16%, respectively. Flutic asone (1,000 mu g, twice,daily) was more suppressive than BUD (800 mu g, tw ice daily) (p = 0.0006). The FEV1, measured the morning after the last inha lation, was significantly higher after the active treatments, compared with placebo (p < 0.02), but did not differ between all active treatments. We c onclude that high doses of BUD and FP tin particular the latter), inhaled v ia their respective dry powder inhalers for 1 wk, result in a measurable sy stemic activity in patients with asthma.