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Long-term effect of budesonide on hypothalamic-pituitary-adrenal axis function in children with mild to moderate

Leonard B Bacharier1, Hengameh H Raissy, Laura Wilson

  • 1Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri 63110, USA. bacharier_l@kids.wustl.edu

Pediatrics
|June 3, 2004
PubMed

Insights

Long-term budesonide for pediatric asthma showed no negative impact on the hypothalamic-pituitary-adrenal (HPA) axis. This 3-year study confirms budesonide safety in children with mild to moderate asthma.

Area of Science:

  • Pediatric Endocrinology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Inhaled corticosteroids (ICS) are standard therapy for persistent asthma in children.
  • Concerns exist regarding the long-term safety of ICS, particularly effects on the hypothalamic-pituitary-adrenal (HPA) axis.
  • Budesonide is a commonly prescribed ICS for pediatric asthma management.

Purpose of the Study:

  • To evaluate the safety of 36-month budesonide administration on HPA axis function in children with mild to moderate asthma.
  • To assess the cumulative effects of budesonide on HPA axis function over a three-year period.

Main Methods:

  • Ancillary study of the Childhood Asthma Management Program (CAMP) involving 63 children.
  • HPA axis function assessed via serum cortisol response to adrenocorticotrophic hormone (ACTH) stimulation and 24-hour urinary free cortisol excretion at baseline, 12, and 36 months.
  • Children received continuous therapy with budesonide (400 microg/day), nedocromil (16 mg/day), or placebo.

Main Results:

  • No significant differences in serum cortisol levels post-ACTH stimulation were observed between treatment groups at any time point.
  • Urinary free cortisol excretion remained similar across groups at 36 months, after adjusting for relevant covariates.
  • Cumulative exposure to inhaled budesonide did not correlate with altered HPA axis function.

Conclusions:

  • Chronic budesonide treatment at 400 microg/day is safe for HPA axis function in children with mild to moderate asthma.
  • No cumulative adverse effects on HPA axis function were detected over a three-year treatment period.
  • These findings support the long-term safety profile of budesonide in pediatric asthma management.
Abstract

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