Evaluation of bone metabolism after the use of an inhaled glucocorticoid (flunisolide) in patients with moderate asthma

CONCLUSIONS The use of inhaled flunisolide 1000 mu g/day for 10weeks had no suppressive effect on adrenal function in the majority of asthmatic patien ts studied, However, the effects seen on bone and mineral metabolism, evide nced by the significant fall in osteocalcin and pyridinoline levels, may in dicate a possible systemic effect of this drug. Clinical consequences of lo ng-term treatment with flunisolide need to be further evaluated, OBJECTIVE We have investigated the effects of the inhaled corticosteroid fl unisolide on bone metabolism and adrenal function in patients with moderate asthma, SUBJECTS AND DESIGN Twenty ambulatory patients (13 females, 7 males, mean a ge +/- SD of 36.4 +/- 12.4 years) with moderate asthma were recruited, None had taken corticosteroids for at least 1 month. Flunisolide 500 mu g was g iven twice a day for 10weeks, without any other medication. Blood and urine were collected before and at the end of treatment course. Cortisol (basal and Ih after ACTH 250 mu g i,v,) was measured to evaluate adrenal function. A peak cortisol response of 496 nmol/l was considered an adequate response . Serum ionized calcium, intact PTH, plasma osteocalcin (OC) and urinary py ridinoline (Pyr) and deoxy-pyridinoline (D-Pyr) were measured to evaluate b one metabolism, Wilcoxon paired test was performed for statistical analysis . Results are expressed as mean i SD. RESULTS In most patients (85%), there was no difference after treatment wit h flunisolide on basal and stimulated cortisol levels. We found a significa nt decrease of CC (3.55 i 1.42 to 2.97 +/- 1.05 nmol/l) and Pyr (66.4 +/- 2 0.0 to 59.5 +/- 24.9 pmol/mu mol creatinine) levels after treatment (P<0.05 ). We also observed a positive correlation between the variations seen in p re and post treatment values of CC and Pyr/D-Pyr.