Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis...

Area of Science:

• Pediatric Endocrinology
• Respiratory Medicine
• Clinical Pharmacology

Background:

• Recent pediatric asthma guidelines fail to address hypothalamic-pituitary-adrenal (HPA) axis suppression.
• Corticosteroid therapy in children with asthma carries a risk of HPA axis suppression.
• Evidence regarding HPA axis suppression in pediatric asthma is not systematically evaluated in current guidelines.

Purpose of the Study:

• To review existing literature on HPA axis suppression in children with asthma treated with corticosteroids.
• To assess the quality of evidence concerning HPA axis suppression.
• To develop evidence-based recommendations for the diagnosis, screening, and management of HPA axis suppression using the GRADE approach.

Main Methods:

• Systematic literature review of studies on HPA axis suppression in pediatric asthma.
• Quality assessment of evidence using established criteria.
• Application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Main Results:

• The review identified gaps in the literature and assessed the quality of available evidence.
• Specific findings regarding the prevalence and clinical significance of HPA axis suppression were evaluated.
• The GRADE approach was utilized to formulate recommendations based on the evidence quality.

Conclusions:

• Current pediatric asthma management guidelines require updating to include HPA axis suppression.
• Evidence supports the need for screening and management strategies for HPA axis suppression in children on corticosteroids.
• Recommendations are provided for clinical practice to ensure comprehensive care for asthmatic children.