Inhaled steroids suppress cortisol production even at low doses

Studies of the effect of inhaled corticosteroids (ICSs) on cortisol suppression show inconsistent results.

This meta-analysis included 31 studies of adults with asthma and evaluated the cortisol suppression in the low-, medium-, and high-dose of ICS. The results were as follows:

- low-dose ICS -- 17.92% cortisol suppression
- medium-dose ICS -- 26.55% cortisol suppression
- high-dose -- 36.31% cortisol suppression

The authors concluded that significant cortisol suppression was evident even at at low doses of ICSs and increased with dose.

ICS dose should be titrated down to the minimum required to maintain symptom control.

Impact of inhaled corticosteroids on cortisol suppression in adults with asthma: a quantitative review. Annals of Allergy, Asthma and Immunology, 2008, vol. 100, no. 1, pp. 23 - 30.
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