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Repeatability of the low-dose ACTH test in asthmatic children on inhaled corticosteroids

Atul Gupta1, Tim Cheetham, Clare Jaffray

  • 1Department of Respiratory Paediatrics, Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.

Acta Paediatrica (Oslo, Norway : 1992)
|August 22, 2009
PubMed

Insights

The low-dose Synacthen test (LDST) shows fair to good repeatability in children with asthma on high-dose fluticasone propionate (FP). However, its inconsistency suggests it may not be reliable enough for clinical decisions regarding adrenal function in these patients.

Area of Science:

  • Pediatric Endocrinology
  • Respiratory Medicine
  • Pharmacology

Background:

  • High-dose fluticasone propionate (FP) is commonly used for asthma management in children.
  • Inhaled corticosteroids (ICS) can affect adrenal function, necessitating reliable testing.
  • The low-dose Synacthen test (LDST) is used to assess adrenal reserve.

Purpose of the Study:

  • To evaluate the repeatability of the low-dose Synacthen test (LDST).
  • To assess LDST reliability in pediatric asthma patients receiving high-dose fluticasone propionate (FP).

Main Methods:

  • Eighteen children with stable chronic asthma on high-dose FP (> or =500 microg/day) underwent LDST.
  • The test was repeated one month later.
  • Repeatability was analyzed using the Kappa statistic.

Main Results:

  • Fifteen out of 18 patients (83%) had consistent test results (either both normal or both abnormal).
  • Three patients (17%) showed inconsistent results between the two tests.
  • The Kappa statistic was 0.56, indicating fair to good agreement.

Conclusions:

  • The LDST, under the tested protocol, demonstrates only fair to good repeatability in asthmatic children on high-dose FP.
  • The observed inconsistency raises concerns about its suitability for critical patient management decisions.
  • Further refinement of the LDST protocol may be needed for reliable adrenal function assessment in this population.
Abstract

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