Yüksek doz inhale fluticasone propionate ve budesonide'in astımlı hastalarda sistemik yan etki potansiyellerinin karşılaştırılması

Amaç: Çalışmamızda astım tedavisinde en çok tercih edilen inhale kortikosteroidler (KS) olan Flutkasone Propionate (FP) ve Budesonide (B)'in sistemik yan etki yapma potansiyellerini sabah ölçülen plazma kortizol düzeylerine bakarak karşılaştırmayı amaçladık. Materyal ve Metot: Çalışmaya en az 6 aydır minimum 1000 mcg/gün inhale FP (n=33) veya B (n=36) kullanan toplam 69 orta-persistan veya ileri evre astımlı hasta dahil edildi. Bulgular: FP kullanan 1. gruptaki hastaların yaş ortalaması 49.2±15.2 yıl, B kullanan 2. gruptaki hastaların yaş ortalaması ise 48,1±12,2 yıl idi (p>0.05). Hastaların tamamı en az 20 gündür hiçbir sistemik ilaç kullanmıyordu. Sabah kortizol düzeyi ölçümleri 08.00 ve 09.00 arasında yapıldı. Birinci grubun ortalama sabah kortizol değeri 10.3±4.6 mcg/dl, 2. grubunki ise 10.4±5.4 mcg/dl seviyesindeydi (p>0.05). Kontrol grubu olarak alınan 20 kişilik herhangi bir ilaç kullanmayan yaşça benzer sağlıklı hastane personelinin ortalama sabah kortizol düzeyi ise 16.0±5.3 mcg/dl olup, 1. grubun ortalama kortizol düzeyleri kontrol grubuna göre istatistik! olarak anlamlı derecede düşüktü (p=0.01). 1. gruptaki 4 hastanın (%12.1), 2. gruptaki 6 hastanın (%16.7) sabah plazma kortizol düzeyleri klinik olarak önemli sonuçlar doğurabilecek kadar düşük ölçülürken, kontrol grubunda bu derecede düşük bir değere rastlanmadı. Çalışmamızda yüksek doz inhale FP ve B kullanan astımlı hasta grupları arasında sistemik yan etkilere yol açma potansiyeli açısından fark bulunmazken (p>0.05); FP kullanan hastaların % 12.1'inde ve B kullananların ise %16.7'sinde ciddi klinik sonuçlar doğurabilecek derecede düşük kortizol seviyeleri tesbit edildi. Sonuç: Biz bu tip yüksek doz inhale steroid kullanan ve sistemik yan etkilere karşı hassas hastaların önceden saptanabilmesi amacı ile belli aralıklarla sabah kortizol düzeylerinin ölçülmesi gerektiğini düşünüyoruz.

Comparison of potential for systemic side effects with high dose inhaled fluticasone propionate and budesonide in asthmatic patients

Background: In our study, we aimed to compare the potential for systemic side effects of two most frequently preferred inhaled corticosteroids (CS) in the treatment of asthma, Fluticasone Propionate (FP) and Budesonide (B), by evaluating morning plasma cortisol levels. Materials and method: The study included 69 moderate-persistent and severe asthmatic patients using minimal 1000 meg/day FP (n=33) or B (n=36) for at least 6 months. The mean age of the patients was 49.2±15.2 years in the f group using FP, and was 48.1±2.2 years (p>0.05) in the 2nd group using B. Patients were not utilizing any systemic drugs for the last 20 days and their morning plasma cortisol level measurements were performed between 08.00 and 09.00 a.m. Results: Mean plasma cortisol level of the f group was 10.3±4.6 mcg/dl and that of the 2nd group was 10.4±5.4 mcg/dl (p>0.05). Mean plasma cortisol level of the age matched healthy hospital personeli was 16.0±5.3 mcg/dl and the mean cortisol level of the 1st group was significantly lower than the control group (p0.01). Four patients (12.1%) in the 1st group and six patients (16.7%) in the 2nd group had extremely low plasma cortisol levels, but such low levels were not measured in the control group at all. Conclusion: We could not define any difference between asthmatic patient groups utilising FP and B regarding their potentials for systemic side effects (p>0.05); on the other hand 12.1 % of the patients utilising FP and 16.7 % of the patients utilising B had extremely low plasma levels of cortisol, which could lead to clinically important outcomes. We think that early morning plasma cortisol levels should be measured at certain intervals in patients utilising high dose of inhaled CS to detect the patients vulnerable to systemic side effects.

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