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The relation between adrenal function and the severity of bronchial hyperresponsiveness in children as measured by
J Barr1, M J Rapoport, T Tauber
1Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Children with severe asthma may experience relative adrenal insufficiency. Severely asthmatic children showed significantly lower 24-hour urinary free cortisol (UFC) excretion after ACTH stimulation compared to those with milder disease.
Area of Science:
- Pediatric Pulmonology
- Endocrinology
- Asthma Research
Background:
- Asthma severity varies significantly among individuals, with unclear reasons for extreme differences.
- Understanding the underlying mechanisms of severe asthma attacks is crucial for effective management.
Purpose of the Study:
- To investigate the hypothesis that children with more severe asthma exhibit relative adrenal insufficiency compared to those with milder disease.
- To explore the relationship between asthma severity and adrenal function in pediatric patients.
Main Methods:
- Studied 16 children (aged 8-16) with chronic asthma.
- Assessed adrenal function via 24-hour urinary free cortisol (UFC) and plasma cortisol levels post-ACTH stimulation.
- Evaluated bronchial hyperresponsiveness using the methacholine provocation test.
Main Results:
- No significant difference in peak plasma cortisol response to ACTH between mild-moderate (Group A) and severe (Group B) bronchial hyperresponsiveness groups.
- Severely asthmatic children (Group B) demonstrated significantly lower 24-hour UFC response to ACTH compared to Group A (p <0.01).
Conclusions:
- Severely asthmatic children in the study exhibited reduced 24-hour UFC secretion, suggesting potential relative adrenal insufficiency.
- Recommend providing a short course of inhaled steroids for home emergency use in high-risk asthma patients identified with this profile.
Background:
There is no satisfactory explanation why some individuals experience severe attacks of asthma, yet others, exposed to similar stimuli, have a milder form of the disease.
Objective:
We tested the hypothesis that children with more severe disease may have relative adrenal insufficiency compared to the children with milder disease.
Patients And Methods:
Sixteen children with chronic asthma aged 8-16 years old were studied. Adrenal function was evaluated by the 24-h excretion of urinary free cortisol (UFC) before and after ACTH stimulation, and by plasma cortisol levels before and 60 min after ACTH administration. The severity of bronchial hyperresponsiveness was evaluated by the methacholine provocation test.
Results:
Nine children had 20% fall in forced expiratory volume in 1 sec (FEV1) after a provocative concentration (PC20FEV1) of methacholine > or =2.5 mg/ml and were considered as having mild-moderate bronchial hyperresponsiveness (Group A). Seven children had a PC20FEV1 of < or =1.25 mg/ml and were considered as having severe bronchial hyperresponsiveness (Group B). No significant difference was found between the peak plasma cortisol response to ACTH between the two groups (634+/-182 and 586+/-137 nmol/l, respectively). However, there was a significant statistical difference (p <0.01) in the 24-h UFC response to ACTH between the children from Group A (345+/-107 nmol/m2 ) and the children from Group B (161+/-125 nmol/m2).
Conclusions:
Based on the low levels of 24-h UFC secretion in severely asthmatic children in our study, we propose the encouragement of provision of a short course of inhaled steroids to be kept at home for the emergency therapy of those children identified as having high-risk asthma.