Systemic effect comparisons of six inhaled corticosteroid preparations

Richard J. Martin, Stanley J. Szefler, Vernon M. Chinchilli, Monica Kraft, Myrna Dolovich, Homer A. Boushey, Reuben M. Cherniack, Timothy J. Craig, Jeffrey M. Drazen, Joanne K. Fagan, John V. Fahy, James E. Fish, Jean G. Ford, Elliott Israel, Susan J. Kunselman, Stephen C. Lazarus, Robert F. Lemanske, Stephen P. Peters, Christine A. Sorkness

Research output: Contribution to journalArticle

216 Citations (Scopus)

Abstract

The goal of this study was to establish a reliable method to evaluate systemic bioavailability and to determine equisystemic effects (microgram dose producing equal systemic cortisol suppression) of inhaled corticosteroids (ICS). Steroid naive asthma subjects (n = 156) were enrolled at six centers. A 1-week doubling dose design was used for each of six ICS and matched placebos for a total of four doses. Systemic effect was evaluated by hourly plasma cortisol concentrations (8 P.M. to 8 A.M.), 12- and 24-hour urine cortisol concentrations, and a morning blood osteocalcin. The area under the concentration-time curve for hourly cortisol concentrations was the best outcome variable to assess systemic effect. For the six ICS and matching placebos (beclomethasone-chlorofluorocarbon [CFC], budesonide dry powder inhaler [DPI], fluticasone DPI, fluticasone-CFC metered close inhaler [MDI], flunisolide-CFC, and triamcinolone-CFC), only the placebo group and fluticasone DPI did not demonstrate a significant dose-response effect. Thus microgram comparison of all ICS could only be performed at a 10% cortisol suppression: flunisolide-CFC - 936; triamcinolone-CFC - 787; beclomethasone-CFC - 548; fluticasone DPI - 445; budesonide DPI - 268; fluticasone-CFC MDI - 111. This study represents the first step in evaluation of ICS efficacy based on equisystemic (cortisol suppression) effects of a given ICS, rather than doses judged arbitrarily to be comparable on a microgram basis.

Original languageEnglish (US)
Pages (from-to)1377-1383
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume165
Issue number10
DOIs
StatePublished - May 15 2002

Fingerprint

Chlorofluorocarbons
Dry Powder Inhalers
Adrenal Cortex Hormones
Hydrocortisone
flunisolide
Beclomethasone
Triamcinolone
Budesonide
Nebulizers and Vaporizers
Placebos
Osteocalcin
Biological Availability
Asthma
Steroids
Fluticasone
Urine

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Martin, R. J., Szefler, S. J., Chinchilli, V. M., Kraft, M., Dolovich, M., Boushey, H. A., ... Sorkness, C. A. (2002). Systemic effect comparisons of six inhaled corticosteroid preparations. American journal of respiratory and critical care medicine, 165(10), 1377-1383. https://doi.org/10.1164/rccm.2105013
Martin, Richard J. ; Szefler, Stanley J. ; Chinchilli, Vernon M. ; Kraft, Monica ; Dolovich, Myrna ; Boushey, Homer A. ; Cherniack, Reuben M. ; Craig, Timothy J. ; Drazen, Jeffrey M. ; Fagan, Joanne K. ; Fahy, John V. ; Fish, James E. ; Ford, Jean G. ; Israel, Elliott ; Kunselman, Susan J. ; Lazarus, Stephen C. ; Lemanske, Robert F. ; Peters, Stephen P. ; Sorkness, Christine A. / Systemic effect comparisons of six inhaled corticosteroid preparations. In: American journal of respiratory and critical care medicine. 2002 ; Vol. 165, No. 10. pp. 1377-1383.
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Martin, RJ, Szefler, SJ, Chinchilli, VM, Kraft, M, Dolovich, M, Boushey, HA, Cherniack, RM, Craig, TJ, Drazen, JM, Fagan, JK, Fahy, JV, Fish, JE, Ford, JG, Israel, E, Kunselman, SJ, Lazarus, SC, Lemanske, RF, Peters, SP & Sorkness, CA 2002, 'Systemic effect comparisons of six inhaled corticosteroid preparations', American journal of respiratory and critical care medicine, vol. 165, no. 10, pp. 1377-1383. https://doi.org/10.1164/rccm.2105013

Systemic effect comparisons of six inhaled corticosteroid preparations. / Martin, Richard J.; Szefler, Stanley J.; Chinchilli, Vernon M.; Kraft, Monica; Dolovich, Myrna; Boushey, Homer A.; Cherniack, Reuben M.; Craig, Timothy J.; Drazen, Jeffrey M.; Fagan, Joanne K.; Fahy, John V.; Fish, James E.; Ford, Jean G.; Israel, Elliott; Kunselman, Susan J.; Lazarus, Stephen C.; Lemanske, Robert F.; Peters, Stephen P.; Sorkness, Christine A.

In: American journal of respiratory and critical care medicine, Vol. 165, No. 10, 15.05.2002, p. 1377-1383.

Research output: Contribution to journalArticle

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T1 - Systemic effect comparisons of six inhaled corticosteroid preparations

AU - Martin, Richard J.

AU - Szefler, Stanley J.

AU - Chinchilli, Vernon M.

AU - Kraft, Monica

AU - Dolovich, Myrna

AU - Boushey, Homer A.

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AU - Craig, Timothy J.

AU - Drazen, Jeffrey M.

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AU - Fahy, John V.

AU - Fish, James E.

AU - Ford, Jean G.

AU - Israel, Elliott

AU - Kunselman, Susan J.

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