The present study identified three patients with
bronchiectasis receiving inhaled
corticosteroids (ICSs) who had symptomatic adrenal suppression secondary to ICS. The prevalence of adrenal suppression is unknown in
bronchiectasis. The frequency of adrenal suppression and the impact of ICS use in
bronchiectasis patients were examined. In total, 50 outpatients (33 receiving ICSs) underwent a short Synacthen test and completed a St George's Respiratory Questionnaire (SGRQ). Symptoms of adrenal suppression,
steroid use and lung function were compared between subjects who were suppressed and those who were not. Adrenal suppression was evident in 23.5% of subjects who did not receive ICSs and 48.5% of those who did. Basal
cortisol and the increments by which
cortisol increased 30 min after Synacthen were lower in suppressed than in nonsuppressed subjects. The incremental
cortisol rise was negatively correlated with SGRQ impacts and total score, suggesting a worse quality of life in those who had an impaired adrenal response. The greatest frequency of generalised symptoms was seen in the suppressed group. A significant proportion of subjects with
bronchiectasis have evidence of adrenal suppression, and this is increased when inhaled
corticosteroids are also used. Impairment of the
cortisol response to stimulation is associated with poorer health status.