I have been taking inhaled fluticasone (flovent) 1000 mcg per day
(500 mcg am, 500 mcg pm) for the last couple of years.  Over the last few
months I have noticed that if I miss one or more doses I experience severe
exhaustion, espcially if I miss say 2 or 3 consecutive doses.  The exhaustion
is more pronounced if I miss the morning dose than the evening dose (possibly
because I'm usually asleep after the evening dose!).  The main symptom is
overwhelming tiredness forcing me to go and lie down during the day, or
sleeping 12 hours overnight and then feeling absolutely terrible and exhausted
on waking.  No amount of sleep seems to resolve the exhaustion.  If however
I restore the fluticasone dose the exhaustion largely goes away and
I can function more or less normally.  I have found by repeated
experiment that the exhaustion symptoms are consistently reproducible by
missing 1 or more fluticasone doeses, and go away within a day or so of
re-introducing the full fluticasone dose.

My specialist recently tried substituting 50% of the fluticasone dose with qvar
beclamethasone (a small particle form of beclamethasone).  This was
unrelated to the fatigue symptoms, the aim was to try to improve the
asthma control which is not fully controlled by the flovent.  The amount
of beclamethasone substituted was calculated by the specialist to be
equivalent to half of the fluticasone done, so the the combined effect
of the two drugs should be the same as the original 1000 mcg/day flovent.

On taking the qvar and reduced flovent doses I found I got similar exhaustion
to missing the fluticasone dose, so the qvar doesn't seem to have the same
systemic effect as the fluticasone.  After 1-2 days it became apparant
that I would have to switch back to the full 500 mcg fluticasone dose
in the morning to avoid the exhaustion.

I have conducted an internet search and have found there have been a few
published studies showing adrenal suppression from inhaled fluticasone, but
these are mainly results obtained from children, whereas I am an adult male.

My specialist has told me that systemic effects for inhaled steroids are
very rare and unlikely since the dose is small and absorbtion from the
lungs into the body is supposedly minimal.  The patient information
leaflet that comes with the fluticasone inhaler also claims that
systemic effects from use of the inhaler are "very rare".
(Of course, I recognise that "very rare" does not mean "never").

My questions for the group are:-

(1) Are the exhaustion symptoms I have described consistent with some
degree of adrenal suppression resulting from use of the fluticasone
inhaler?

(2) Is there any other mechanism other than adrenal suppression that
would be consistent with the apparant correlation between reducing
the fluticasone dose and experiencing exhaustion symptoms?

(3) Is flovent adrenal suppression a known issue?  Have other people
experienced similar reactions?

(4) Is there a reliable test for adrenal suppression that I could ask
my specialist to carry out?

(5) Does fluticasone (flovent) have a worse profile for systemic effects
and adrenal suppression in particular than beclamethasone or budenoside?

I'll be very grateful for any information received.

Sorry for the long post!

-- gumbo