Editor's Correspondence |

Relative Effects of Exogenous Inhaled Corticosteroids on Diurnal Cortisol Secretion

Brian J. Lipworth, MD, FRCPE
Arch Intern Med. 2000;160(16):2546. doi:.
Text Size: A A A
Published online


I read with interest the recent article by Brus1 on the effects of high-dose inhaled corticosteroids on 24 hour AUC (AUC24) plasma cortisol profiles in healthy adults. A within treatment comparison for placebo at baseline vs steady state showed significant suppression for all inhaled corticosteroids except for flunisolide. This is potentially misleading because flunisolide had the lowest placebo baseline value for AUC24 cortisol, and consequently, it is perhaps not surprising that the percentage suppression would be of a smaller magnitude. Indeed, performing statistical comparisons on placebo values between the 5 treatment groups (using unpaired Student t test) reveals a lower placebo value for flunisolide vs fluticasone proprioate (P<.01), vs budesonide (P<.05), and vs triamcinolone acetonide (.05 <P< .10). Because of the confounding effects of the different placebo baseline values, it is invalid to perform between-treatment comparisons for the percentage suppression of AUC24 cortisol calculated as percentage change from baseline. Indeed, when using a pooled value as the mean placebo value for all 5 treatment groups (ie, pooled value of 1225 ng · mL−1 · h−1), a different picture emerges in terms of the percentage of steady-state suppression: budesonide, 13%; flunisolide, 17%; triamcinolone, 23%; beclomethasone dipropionate, 36%; and fluticasone, 78%.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles