Comparison of the systemic availability of fluticasone propionate in healthy volunteers and patients with asthma

Objectives: The aim of this analysis was to compare the systemic exposure to inhaled fluticasone propionate (FP) after administration of either single or repeated dose regimens via dry powder and metered-dose inhalers in patients with asthma and healthy volunteers. Background: The pharmacokinetics of FP, a topically active glucocorticoid administered by inhalation for the treatment of asthma and rhinitis, are well characterised in healthy volunteers. As asthma is characterised by pathophysiological changes in the lung, it may be inappropriate to use data from studies in healthy volunteers to predict the deposition and absorption of FP in patients with asthma. Methods and results: Pooled data from 13 pharmacokinetic studies showed that the systemic availability of FP (measured as area under the plasma FP concentration-time curve) after single or multiple administration by inhalation was 2 to 3 times lower in patients with asthma than in healthy volunteers. This observation correlated well with the systemic effects of FP in the 2 groups. Reduction in 24-hour urinary cortisol excretion after inhalation of EP (determined in 9 of the studies) was greater in healthy volunteers than in patients with asthma. The hypothalamic-pituitary-adrenal axis suppression caused by systemic exposure to FP in adults with asthma is therefore substantially less than that in healthy volunteers. Conclusion: Differences in the deposition of FP in the lungs of patients with asthma, probably caused by obstructed inspiratory airflow, may explain this observation.