Allergy.  1994 Jun;14(2):188-198.

Effect of Steroid Inhalation on the Bronchial reactivity and HPA axis in Asthmatics

• Lee DH
• Koong SS
• Kim MK

Abstract

Although nowadays inhaled steroid is known as the safe and potent anti-inflammatory, anti-allergic drug and recommanded as the first-line therapeutic drug in asthma, still there are many controversies about its side effects. In this study, We evaluated the effect of inhaled steroid on the bronchial hyperresponsiveness and side effects including hypothalamo-pituitary-adrenal axis(HPA axis) in mild to moderate 15 asthmatics including 4 extrinsic asthmatics confirmed by the skin prick, RAST and bronchial challenge tests, with using 400 micro gram of Beclomethasone daily for 10 months to confirm the inhaled steroid really effective and safe for long-term use in asthmatics. Each of the non-specific and allergen specific bronchial hyperresponsiveness(NSBR, SBR) was measured by methacholine and allergen bronchial provocation test and extracted PC20-Meth. PD20-allergen respectively before and after use. Side effect such as symptoms and signs of Cushing syndrome by physical examinations, Diabetes mellitus(DM) by fasting and postprandial 2hour blood sugar level(FBS, PP2) before, and every 2 months. The suppression of hypothalamo-pituitary-adrenal axis(HPA axis) was measured with the blood cortisol at 8am, 4pro and their diurnal variation and rapid ACTH test before and after by the Amersham Cortisol Ria Kit. No one showed the cyshingoid features, DM and changes periphreral eosinophil counts. But 2 patients showed HPA axis suppression to the rapid ACTH test, one of them also showed the diurnal variation of the daily cortisol level and one of them was very mild asthmatics. NSBH was decreased in 13 patients, which scale is small but SBH was not significantly decreased. Taken together, we confirmed the slightly positive effect of inhaled steroid on the NSBH, also found HPA axis suppression even with usual recomanded dose. Even using inhaled steroid, like oral we must do careful follow-up and prescribe as low as possible, and reconsider whether we use inhaled steroid as the first ling drug in very mild asthmatics.

MeSH Terms

Adrenocorticotropic Hormone
Asthma
Axis, Cervical Vertebra*
Beclomethasone
Blood Glucose
Bronchial Provocation Tests
Cushing Syndrome
Eosinophils
Fasting
Follow-Up Studies
Humans
Hydrocortisone
Inhalation*
Methacholine Chloride
Physical Examination
Skin
Adrenocorticotropic Hormone
Beclomethasone
Blood Glucose
Hydrocortisone
Methacholine Chloride