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| |  Inhaled Fluticasone Has Impact on Hormonal, Inflammatory Responses to Exercise: Presented at AAAAI By Carole VanSickle Ellis NEW ORLEANS -- March 4, 2010 -- Physicians prescribing inhaled fluticasone may need to consider this corticosteroid’s impact on the peripheral immune system in patients with asthma, researchers said here on February 28 at the 2010 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting. While fluticasone has been believed to remain largely in the lungs, when it is paired with exercise the circulation levels of fluticasone increase significantly and this may have a physiological impact on the patient and on the hypothalamic-pituitary-adrenal (HPA) axis. Christina D. Schwindt, MD, Division of Allergy & Immunology, University of California, Irvine, Irvine, California, and colleagues enrolled 22 healthy adult males for the study. However, half of these patients were excluded from the final analysis because of abnormal pulmonary function testing, voluntary withdrawal, or the development of colds and cold symptoms during the testing period. The 11 remaining healthy males, aged 18 to 30 years, reported for 3 visits every 14 days. Visit 1 (pretreatment evaluation) consisted of a physical examination, medical history, and a standardised protocol to screen for exercise-induced bronchoconstriction. Visit 2 consisted of 30 minutes of exercise on a cycle ergometer at 70% peak work rate, blood samples taken pre- and post exercise so that cytokines and HPA axis mediators could be measured, and administration of fluticasone propionate 220 mcg 2 puffs twice daily for 2 weeks. On the third visit (post-treatment evaluation) -- 14 days weeks after visit 2 -- patients repeated the same 30 minutes of heavy-intensity exercise as visit 2. Blood samples were again taken pre- and post exercise. The researchers found no difference between the pretreatment and post-treatment evaluations, although oxygen consumption increased (P = .012). After the inhaled corticosteroid (ICS) treatment, patients had a blunted exercise response for cortisol, adrenocorticotropic hormone, and growth hormone. In addition, peripheral leucocytes and neutrophils increased in response to exercise. Circulating mean fluticasone levels were 0.15 ng/mL and increased to 0.22 ng/mL in response to exercise; 75% of fluticasone was delivered to peripheral circulation in response to exercise. The researchers determined that exercise was a good tool to reveal deficits of the HPA axis and growth hormone production after ICS treatment, even if those deficits are not identified by static markers. Additionally, neutrophils can be used as sensitive surrogate markers of the systemic effects of ICS. Since exercise significantly increases circulating levels of fluticasone in the system, exercise tests should be considered an option when a physician needs to assess subtle, physiological impacts of exogenous corticosteroids on the system, the researchers said.
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