Effect of Long-term Inhaled Corticosteroids on the Hypothalamic-Pituitary-Adrenal Axis in Children with Asthma
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Published on: April 25, 2016
Lekshmi Sambhu Hema1, Prawin Kumar2, Jagdish Prasad Goyal1
1Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Insights
Long-term use of inhaled corticosteroids (ICS) is safe for children with asthma. While some showed low cortisol levels, none experienced clinical adrenal insufficiency, indicating the hypothalamic-pituitary-adrenal (HPA) axis remains largely unaffected.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are a cornerstone therapy for childhood asthma.
- Concerns exist regarding potential long-term effects of ICS on the hypothalamic-pituitary-adrenal (HPA) axis in pediatric populations.
- Assessing HPA axis function is crucial for understanding the safety profile of chronic ICS use.
Purpose of the Study:
- To evaluate the impact of prolonged inhaled corticosteroid (ICS) treatment on the hypothalamic-pituitary-adrenal (HPA) axis in children with asthma.
- To determine the prevalence of HPA axis suppression in pediatric asthma patients undergoing long-term ICS therapy.
- To investigate potential correlations between ICS dosage, asthma control, and HPA axis function.
Main Methods:
- A cohort of 78 children (aged 5-18 years) with asthma on ICS for at least 6 months was studied.
- Initial screening involved measuring fasting morning cortisol levels, with values <15 mcg/dl considered low.
- Children with low initial cortisol underwent an adrenocorticotropic hormone (ACTH) stimulation test, with post-stimulation cortisol <18 mcg/dl indicating HPA axis suppression.
Main Results:
- Of the 78 children, 4 (5.1%) exhibited low post-ACTH stimulation cortisol levels, suggesting potential HPA axis impairment.
- No statistically significant correlation was found between low post-ACTH cortisol levels and either the ICS dose or asthma control status.
- Crucially, none of the children displayed clinical signs or symptoms indicative of adrenal insufficiency.
Conclusions:
- While a small percentage of children on long-term ICS therapy showed biochemical evidence of HPA axis alteration, none presented with clinical adrenal insufficiency.
- These findings support the safety of inhaled corticosteroids for long-term asthma management in children.
- Inhaled corticosteroids appear to be a safe therapeutic option for pediatric asthma, even with extended use.
Objectives:
To assess the effect of the long-term use of inhaled corticosteroids (ICS) on the hypothalamic-pituitary-adrenal (HPA) axis.
Methods:
Children (5-18 y) diagnosed with asthma and on ICS therapy for ≥6 mo were included. In the first step, screening with fasting at 8 AM, cortisol level was measured; a value <15 mcg/dl was considered low. Children with low fasting cortisol levels were subjected to adreno-corticotropic hormone (ACTH) stimulation test in the second step. Post-ACTH stimulation, cortisol level <18 mcg/dl was considered to have HPA axis suppression.
Results:
A total of 78 children (males 55, 70.5%) diagnosed with asthma, with a median age of 11.5 (8, 14) y, were enrolled. The median duration of ICS use was 12 (12-24) mo. The median value of post-ACTH stimulation cortisol level was 22.5 (20.6, 25.5) mcg/dl, and a value <18 mcg/dl was observed in 4 (5.1%; 95% CI 0.2-10%) children. There was statistically no significant correlation between low post-ACTH stimulation cortisol level with ICS dose (p = 0.23) and asthma control (p = 0.67). None of the children had clinical features of adrenal insufficiency.
Conclusions:
In this study, a few children had low post-ACTH stimulation cortisol values; however, none had clinical evidence of HPA axis suppression. Therefore, ICS is a safe drug in children for treating asthma, even for long-term use.
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