Metabolomic profiling reveals adrenal suppression due to inhaled corticosteroid treatment for asthma

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Inhaled cortical steroids (ICS) can help patients manage asthma symptoms, and recent updates to asthma treatment guidelines have expanded recommended low-dose treatment. But concerns persist that ICS could reduce the production of cortisol, a steroid hormone, in the body, leading to adrenal suppression. Although the initial symptoms of adrenal suppression are subtle, continued progression can lead to fatigue, headaches, abdominal pain, vomiting, and psychiatric symptoms.

So far, studies of ICS and adrenal suppression have been limited and have produced conflicting results. To better understand the association between ICS and adrenal suppression, researchers from Brigham and Women’s Hospital and the University of Cambridge conducted the largest metabolomics study of asthma to date. By analyzing the blood plasma of 14,000 people from four independent study cohorts, the team identified 17 steroid metabolites that were reduced in people with asthma and found that even in patients taking low-dose ICS, the use ICS was associated with reduced cortisol levels. The researchers also found significant associations between symptoms of adrenal insufficiency, including fatigue and anemia, in asthma patients taking ICS treatment compared to those not taking it.

The use of ICS helped reduce asthma exacerbations and improve overall quality of life. However, while their effectiveness should not be underestimated, our findings suggest that the risks of ICS use must also be considered.


Jessica Lasky-Su, ScD, Co-Lead Author, Channing Division of Network Medicine, Brigham and Women’s Hospital

“Our work suggests that simple measures, such as regular monitoring of cortisol and prescribing the lowest effective dose of ICS, can help alleviate systemic side effects of ICS use,” said the co-author. principal Claudia Langenberg, MD, PhD, of the MRC. Epidemiology Unit of the University of Cambridge, UK, and Berlin Institute of Health of the Charité Universitätsmedizin, Germany.

Source:

Brigham and Women’s Hospital

Journal reference:

Kachroo, P. et al. (2022) Metabolomic profiling reveals extensive adrenal suppression due to inhaled corticosteroid therapy in asthma. Natural medicine. doi.org/10.1038/s41591-022-01714-5.


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