A comparison of the effects of oral prednisone and inhaled beclomethasone dipropionate on circulating leukocytes

Background: While the side effects of oral glucocorticoids are well recognised there is debate about the systemic effects of high doses of inhaled glucocorticoids such as beclomethasone dipropionate and how these compare with the effects of oral prednisone. Aim: To compare the effects of different doses of oral prednisone and inhaled beclomethasone dipropionate (BDP) on changes in circulating leukocytes. Methods: Changes in different subsets of circulating leukocytes were measured as an index of the systemic effects of inhaled BDP and oral prednisone. We compared the effects of inhaled placebo and 500 and 1000 mu g of inhaled BDP with oral placebo and 2.5, 5 and 10 mg of prednisone in eight healthy volunteers. Leukocyte numbers were measured before and four hours after each dose of medicine. Results: Compared with inhaled placebo, 1000 mu g of inhaled BDP led to a significant increase in neutrophils as a percentage of the total white count (p<0.05) and a significant decrease in the total lymphocyte number (p<0.05) and in the number of CD4 lymphocytes (p<0.05). For 1000 mu g BDP the increase in the % neutrophil count was 8.55% (95% CI 5.17 to 11.93) and the fall in lymphocyte numbers was -0.14x10(9)/L (95% CI 0.06 to -0.34) while 2.5 mg prednisone led to an increase in the % neutrophil count of 9.31% (95% CI 5.82 to 12.80) and a fall in lymphocyte numbers of -0.07x10(9)/L (95% CI 0.05 to -0.19). Conclusions: The systemic effects of 1000 mu g inhaled BDP and 2.5 mg of prednisone are similar.