Measures of hypothalamic-pituitary-adrenal function in patients with asthma treated with inhaled glucocorticoids: Clinical and research implications

In asthmatic patients treated with inhaled glucocorticoids there may be a r isk of suppression of hypothalamic-pituitary-adrenal (HPA) function. The ai m of the present study was to review peer-refereed data on HPA function in asthmatic patients taking inhaled glucocorticoids, and to discuss the value of HPA function measures in clinical practice and research:. There is no e vidence that inhaled glucocorticoids in recommended doses cause clinically significant HPA insufficiency. If sensitive measures of basal adrenal activ ity are used, however, dose-related suppressive effects with specific drugs and application systems can be detected. In adults, fluticasone propionate appears to be more potent than budesonide or triamcinolone acetonide in su ppressing measures of basal adrenal activity. Measures of basal adrenal act ivity are useful in clinical trials that assess and compare systemic activi ty of specific drugs, application devices, and administration regimens, but have no place in the management of asthma.