Comparison of the effect of high-dose inhaled budesonide and fluticasone on adrenal function in patients with severe chronic obstructive pulmonary disease

ABSTRACT

Chronic obstructive pulmonary disease [COPD] is a leading cause of respiratory-related morbidity and mortality. Inhaled steroids are frequently used in patients with moderate to severe disease and may lead to adrenal suppression. The aim of this study was to compare the effect of inhaled budesonide/formoterol with inhaled fluticasone/salmeterol in severe COPD. It was a prospective open-label crossover study of 22 patients. Adrenal suppression was measured by overnight urinary cortisol/creatinine ratio. The measurements were taken while patients were on either combination for at least 4 weeks. A total of 12 patients completed the study. The mean age was 64 years [8 males, 4 females]. The mean FEV1 was 1 L [range, 0.5-1.8]. There was no significant difference in adrenal suppression measured by overnight urinary cortisol/creatinine ratio [budesonide 5.2 +/- 4.3, fluticasone 4.7 +/- 3.1; 95% CI -2.2 to 1.2; P = 0.52] and urinary cortisol concentration [budesonide 51 +/- 53, fluticasone 43 +/- 31 [nmol/l]; 95% CI -35 to 20; P = 0.56]. Inhaled budesonide and fluticasone have no significantly different effect on adrenal function in moderate to severe COPD. The adverse event profile of high-dose inhaled steroids should not influence the choice of medication