Assessment of systemic effects of inhaled glucocorticosteroids: comparison of the effects of inhaled budesonide and oral prednisolone on adrenal function and markers of bone turnover

Eur J Clin Pharmacol. 1991;40(1):77-82. doi: 10.1007/BF00315143.


The effects of inhaled budesonide (BUD) and oral prednisolone (PRED) on markers of bone turnover and adrenal function were compared in a randomized, double-blind, double-dummy, crossover study. Twelve healthy subjects were treated for one week with 0.8, 1.6 and 3.2 mg/day BUD and 5, 10 and 20 mg/day PRED, the three doses being given in ascending order. Plasma cortisol and adrenal cortical androgens showed a significantly decreasing trend with the increasing doses of both drugs, although PRED caused a significantly greater decrease than BUD. Osteoblast function, reflected by serum osteocalcin and alkaline phosphatase was significantly reduced by PRED, but BUD had a significantly different effect as it affected only osteocalcin. Urinary hydroxyproline/creatinine, a marker of bone resorption, was not changed by either drug. The average potency ratio for equivalent systemic effects was PRED:BUD 3.9:1. During short-term treatment at equivalent anti-asthmatic doses, BUD has significantly less effect on adrenal function and bone turnover than PRED, and it may carry less risk of bone complications during long-term treatment.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Administration, Oral
  • Administration, Topical
  • Adrenal Glands / drug effects*
  • Adult
  • Analysis of Variance
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / pharmacology*
  • Bone Resorption / chemically induced
  • Bone and Bones / drug effects*
  • Budesonide
  • Female
  • Humans
  • Hydrocortisone / blood
  • Male
  • Middle Aged
  • Osteocalcin / blood
  • Prednisolone / administration & dosage
  • Prednisolone / pharmacology*
  • Pregnenediones / administration & dosage
  • Pregnenediones / pharmacology*


  • Anti-Inflammatory Agents
  • Pregnenediones
  • Osteocalcin
  • Budesonide
  • Prednisolone
  • Hydrocortisone