MON-154 Inhaled Corticosteroids and Adrenal Insufficiency: A Meta-Analysis and Systematic Review

Inhaled corticosteroids have been associated with adrenal insufficiency in adult and pediatric populations¹,². When inhaled corticosteroids are absorbed orally, they can have a systemic effect. Corticosteroid type, particle size, delivery method, liver metabolism via CYP 3A4, protein binding, and half-life all impact the magnitude of the systemic effect of inhaled corticosteroids³. We conducted a systematic review and meta-analysis in order to establish the prevalence of adrenal insufficiency among adult patients taking inhaled corticosteroids. We searched the PubMed, Embase and Cochrane databases for “adrenal insufficiency” AND “inhaled corticosteroids”, yielding 318 search results. We also hand-searched the references of relevant articles. In total, 30 studies were included in our meta-analysis. Amongst these, 15 studies were RCTs and 13 studies were cross-sectional studies. All of these studies used ACTH stimulation testing to diagnose adrenal insufficiency. Risk of bias assessment was completed for all studies using the Cochrane risk of bias assessment tool. Patients with asthma were the population examined in 90% of the included studies. Prevalence of adrenal insufficiency demonstrated by ACTH stimulation testing varied from under 5% to up to 55% among different studies. We recommend that further studies carefully examine and report the clinical impact of abnormal ACTH stimulation testing results, the concomitant use of oral corticosteroids, and the impact of the inhaled corticosteroid delivery method, the corticosteroid type, the corticosteroid dosage, and the duration of therapy. References: 1. Lapi F, Kezouh A, Suissa S, Ernst P. The use of inhaled corticosteroids and the risk of adrenal insufficiency. Eur Respir J. 2013;42(1)-79-86. 2. Goldbloom EB, Mokashi A, Cummings EA, et al. Symptomatic adrenal suppression among children in Canada. Arch Dis Child. 2017;102(4)-338-339. 3. Ahmet A, Kim H, Spier S. Adrenal suppression- A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol. 2011;7-13.