Suppression of adrenal function in children on inhaled steroids

Inhaled steroid therapy is one of the mainstays of treatment of asthma in children. Side effects, including suppression of the hypothalamic-pituitary-adrenal (HPA) axis, have been noted with high doses of inhaled steroids. Most studies concerning side effects have been done with mechanical nebulization devices or hand-held metered-dose inhalers. The present study attempts to ascertain if dry powder inhalation of beclomethasone dipropionate is associated with any significant suppression of the HPA axis. Fifteen children (10 male and 5 female) between the ages of 4 and 14 years were followed for several years in our outpatient department. They were on inhaled beclomethasone dipropionate at dosages ranging from 6.9 to 25 micrograms/kg per day for 4-24 months. The short adrenocorticotrophic hormone (ACTH) test was used to evaluate function of the HPA axis. Mild suppression of the HPA axis was noted in one of the cases. The study therefore concludes that at therapeutic doses of dry powder beclomethasone dipropionate, suppression of the HPA axis can occur. However, the extent of this complication does not appear to be greater than with hand-held or mechanical nebulization devices.