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Prevalence of hypothalamic-pituitary-adrenal axis suppression in children treated for asthma with inhaled

Ryan W Smith1, Kim Downey, Michelle Gordon

  • 1Department of Medicine and Health, University College Cork, Cork, Ireland;

Paediatrics & Child Health
|May 2, 2013
PubMed

Insights

Inhaled corticosteroids (ICS) can cause hypothalamic-pituitary-adrenal (HPA) axis suppression in children with asthma. Regular screening for HPA axis suppression is recommended, especially for those on high-dose ICS.

Area of Science:

  • Pediatric Endocrinology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Asthma management often involves inhaled corticosteroids (ICS).
  • Long-term ICS use may impact the hypothalamic-pituitary-adrenal (HPA) axis.
  • HPA axis suppression is a potential concern in children receiving ICS therapy.

Purpose of the Study:

  • To investigate the prevalence of HPA axis suppression in pediatric asthma patients using ICS.
  • To identify risk factors associated with HPA axis suppression in this population.

Main Methods:

  • A cohort of 214 children with asthma on ICS was studied.
  • HPA axis suppression was assessed via morning serum cortisol and ACTH stimulation tests.
  • Clinical and demographic data were collected for analysis.

Main Results:

  • HPA axis suppression was detected in 9.3% of the children studied.
  • Increased ICS dosage correlated significantly with higher odds of HPA axis suppression.
  • Suppression was observed in children using 200-500 μg/day of ICS, with no prediction by drug type or duration.

Conclusions:

  • Laboratory evidence confirms HPA axis suppression in children treated with ICS for asthma.
  • Routine screening for HPA axis suppression is advised for children on high-dose ICS (>500 μg/day).
  • Screening may also be beneficial for children on medium-dose ICS.
Abstract

Keywords:
AsthmaHypothalamic-pituitary-adrenal axisInhaled corticosteroid

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