Summary
Twelve healthy males (mean age 27.6 y, range 23–35 y) took part in a randomized, double-blind, crossover study of the effect of blood sampling technique (separate isolated venepunctures vs use of an IV cannula) and frequency (overnight vs morning) on plasma cortisol and white blood cell count after inhalation of a single dose of budesonide 3.2 mg or placebo, in order to establish the more sensitive method for future use.
Sampling technique and frequency affected neither leucocytes nor plasma or urinary cortisol. Budesonide suppressed both plasma and urine free cortisol and delayed the nocturnal rise due to the circadian rhythm, thus reducing the AUC of plasma cortisol vs time.
Lymphocytes, eosinophils and monocytes were decreased and neutrophils and total white blood cells were increased by the high dose of budesonide used. Lymphocytes and neutrophils showed significant changes earlier than eosinophils and cortisol and may be the variables of choice under certain conditions.
Frequent sampling gave more complete information about the systemic effect of the drug than single morning samples.
Similar content being viewed by others
References
Björkander J, Formgren H, Johansson SÅ, Millqvist E (1983) Methodogical aspects on clinical trials with inhaled corticosteroids: results on two comparisons between two steroid aerosols in patients with asthma. Eur J Respir Dis 63 [Suppl 122]: 108–117
Toogood JH, Baskerville JC, Jennings B, Lefcoe NM, Johansson SÅ (1982) Influence of dosing frequency and schedule on the response of chronic asthmatics to aerosol steroid, budesonide. J Allergy Clin Immunol 70: 288–298
Pedersen S, Fuglsang G (1988) Urine cortisol excretion in children treated with high doses of inhaled corticoids: a comparison of budesonide and beclomethasone. Eur Respir J 1: 433–435
Gwinup G, Johnson B (1975) Clinical testing of the Hypothalamic-Pituitary-Adrenocortical system in states of hypo- and hypercortisolism. Metabolism 24: 777–791
Gordon ACH, McDonald CF, Thomson SA, Frame MH, Pottage A, Crompton GK (1987) Dose of inhaled budesonide required to produce clinical suppression of plasma cortisol. Eur J Respir Dis 71: 10–14
Toogood JH, Lefcoe NM, Haines DSM, Jennings B, Errington N, Baksh L, Chuang L (1977) A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma. J Allergy Clin Immunol 59: 289–310
Johansson SÅ, Andersson KE, Brattsand R, Gruvstad E, Hedner P (1982) Topical and systemic glucocorticoid potencies of budesonide and beclomethasone dipropionate in man. Eur J Clin Pharmacol 22: 523–529
Wand GS, Ney RL (1985) Disorders of the hypothalamic-pituitary-adrenal axis. Clin Endocrinol Metab 14: 33–53
Seale JP, Compton MR (1986) Side-effects of corticosteroid agents. Med J Aust 144: 139–142
Toogood JH, Baskerville J, Johansson SÅ (1985) Anomalous effects of steroid treatment on circulating leukocytes. J Allergy Clin Immunol 75: 158
Law CM, Marchant JL, Honour JW, Preece MA, Warner JO (1986) Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet I: 942–944
Saavedra-Delgado AMP, Mathews KP, Pan PM, Kay DR, Muilenberg ML (1980) Dose-response studies of the suppression of whole blood histamine and basophil counts by prednisone. J Allergy Clin Immunol 66: 464–471
Criscuola D, Fraioli F, Bonifacio V, Paolucci D, Isidori A (1980) Effects of a new glucocorticoid, deflazacort, on pituitary-adrenal function in man: a comparison with prednisone. Int J Clin Pharmacol Ther Toxicol 18: 37–41
Schuyler MR, Gerblich A, Urda G (1984) Prednisone and T-cell subpopulations, Arch Intern Med 144: 973–975
Meuleman J, Katz P (1985) The immunologic effects, kinetics and use of glucocorticosteroids. Med Clin North Am 69: 805–816
Webel ML, Ritts RE Jr., Taswell HF, Donadio JV Jr., Woods JE (1974) Cellular immunity after intravenous administration of methylprednisolone. J Lab Clin Med 83: 383–392
Leonard EJ (1987) Two populations of human blood basophils: effects of prednisone on circulating numbers. J Allergy Clin Immunol 79: 775–780
Fauci AS, Dale DC, Balow JE (1976) Glucocorticosteroid therapy: mechanics of action and clinical considerations. Ann Intern Med 84: 304–315
Chiang JL, Patterson R, McGillen JJ, Phair JP, Roberts M, Harris KE, Riesing KS (1980) Longterm corticosteroid effect on lymphocytes and polymorphonuclear cell function in asthmatics. J Allergy Clin Immunol 65: 263–268
Slade JD, Hepburn B (1983) Prednisone-induced alterations of circulating human lymphocyte subsets. J Lab Clin Med 101: 479–487
Nassif E, Weinberger M, Sherman B, Brown K (1987) Extrapulmonary effects of maintenance corticosteroid therapy with alternate-day prednisone and inhaled beclomethasone in children with chronic asthma. J Allergy Clin Immunol 80: 518–529
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jennings, B.H., Andersson, K.E. & Johansson, S.Å. Assessment of the systemic effects of inhaled glucocorticosteroids: the influence of blood sampling technique and frequency on plasma cortisol and leucocytes. Eur J Clin Pharmacol 39, 127–131 (1990). https://doi.org/10.1007/BF00280045
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00280045