Adrenal function in children with severe asthma treated with high-dose inhaled glucocorticoids: recommended screening tests in outpatient conditions
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Published on: April 25, 2016
Anna Breborowicz1, Marek Niedziela
1Department of Pediatric Pneumonology, Allergology and Clinical Immunology, Poznan University of Medical Sciences, Poland.
Insights
Recommended doses of inhaled glucocorticoids (IGC) for severe childhood asthma appear safe for adrenal function. Long-term treatment with fluticasone or budesonide did not significantly impact adrenal suppression in children.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Previous studies suggested adrenal suppression in children with asthma on high-dose inhaled glucocorticoids (IGC).
- This study investigated adrenal function in children with severe asthma on recommended IGC doses.
- Recommended doses were 500-1,000 microg/day fluticasone propionate or equivalent budesonide for ≥12 months.
Purpose of the Study:
- To determine the frequency of adrenal suppression in children with severe asthma.
- To assess the impact of recommended doses of IGC on adrenal function.
- To evaluate cortisol and ACTH levels after a low-dose ACTH stimulation test.
Main Methods:
- Measured serum cortisol and ACTH in 27 children (aged 6-16) with severe asthma.
- Performed low-dose ACTH stimulation tests and measured glucose levels.
- Collected 24-hour urine for free cortisol (UfF) and creatinine.
Main Results:
- 22 out of 27 patients (81.5%) showed normal adrenal function.
- Five patients (18.5%) had reduced basal cortisol levels, but four had normal stimulated levels and UfF.
- One child (3.7%) exhibited suboptimal adrenal function biochemically; all others responded well to stimulation.
Conclusions:
- Long-term treatment with fluticasone (up to 1,000 microg/day) or equivalent budesonide did not substantially affect adrenal function in children with severe asthma.
- Recommended IGC doses are generally safe regarding adrenal function.
- No clinical signs of adrenal hypofunction were observed in the study group.
Background:
A number of previous studies have suggested that adrenal suppression occurs in asthmatic children treated with high-doses of inhaled glucocorticoids (IGC). This study was designed to determine the frequency of adrenal suppression in children with severe asthma treated with recommended doses of IGC: namely 500-1,000 microg/day of fluticasone propionate or the equivalent of budesonide (1,000-2,000 microg/day) for a period of at least 12 months.
Methods:
Early morning cortisol (F) and ACTH serum levels were measured in 27 severe asthmatics aged 6-16 years old. The children underwent a low dose ACTH test (1 microg/1.73 m2) with a parallel glucose measurement. Twenty-four hour urine collection was performed before examination for free F (UfF) and creatinine levels. There were no clinical manifestations of adrenal hypofunction in the analyzed children.
Results:
Of the 27 patients, 22 had normal basal and post-stimulatory levels of F and normal UfF, and the other five (18.5%) had basal serum F levels of <400 nmol/l. Four of the five also had normal post-stimulatory levels of F and normal UfF. One child had a subnormal peak F value of 484 nmol/l during the ACTH test. None of the patients had a suppressed serum ACTH level, but an elevated ACTH level was found in four children. This study provided biochemical evidence of suboptimal adrenal function in one child in the examined group (3.7%) and a good response to stimulation in all the others, even in those with slightly reduced basal cortisol levels.
Conclusion:
This study showed that the use of fluticasone in doses of up to 1,000 microg/day (or the equivalent of budesonide) as long-term treatment of children with severe asthma did not substantially affect their adrenal function.
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