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Decreased cortisol response to insulin induced hypoglycaemia in asthmatics treated with inhaled fluticasone

P Mahachoklertwattana1, K Sudkronrayudh, C Direkwattanachai

  • 1Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand 10400. rapmw@mahidol.ac.th

Archives of Disease in Childhood
|October 23, 2004
PubMed

Insights

Inhaled fluticasone therapy for asthma in children, even at moderate doses for short periods, can lead to adrenal suppression in half of patients. Adrenal function typically recovers after discontinuing the medication.

Area of Science:

  • Pediatric Endocrinology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Inhaled corticosteroids (ICS) are a cornerstone of asthma management.
  • Fluticasone propionate is a widely used ICS.
  • Concerns exist regarding potential systemic side effects of ICS, including adrenal suppression.

Purpose of the Study:

  • To evaluate the impact of inhaled fluticasone propionate on adrenal function in children with asthma.
  • To determine the incidence of adrenal suppression following short-term ICS therapy.

Main Methods:

  • A cohort of 18 asthmatic children (aged 7-17 years) received inhaled fluticasone (250-750 microg/day) for 5-16 weeks.
  • Adrenal function was assessed using the insulin tolerance test (ITT).
  • Adrenal suppression was defined as a 60-minute serum cortisol level below 500 nmol/l.

Main Results:

  • Nine out of 18 children (50%) exhibited adrenal suppression.
  • The median basal and 60-minute cortisol levels were significantly lower in the suppressed group compared to the unsuppressed group.
  • Following a 2-3 month cessation of fluticasone, all previously suppressed patients showed recovery of adrenal function (60-minute cortisol > 500 nmol/l).

Conclusions:

  • Short-term use of inhaled fluticasone propionate at approximately 500 microg/day for up to 16 weeks can cause adrenal suppression in 50% of pediatric asthma patients.
  • The observed adrenal suppression is reversible upon discontinuation of the medication.
Abstract

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