Adrenal suppression secondary to inhaled corticosteroids

Inhaled corticosteroids (ICS) are the foundation of treatment for pediatric asthma, and ICS are significantly safer than repeated courses of systemic steroids. However, systemic effects from ICS include adrenal suppression (AS), which is under recognized and can be life-threatening. Signs and symptoms of AS are often subtle and can be difficult to recognize. The Canadian Pediatric Society and Adrenal Suppression Working Group recommend screening for AS in: asymptomatic children receiving high dose ICS therapy for ≥3 months, any dose ICS in conjunction with a CYP3A4 inhibitor, and any children with AS symptoms, regardless of ICS dose. Screening should be done with a morning serum cortisol, and consultation with Pediatric Endocrinology is warranted if morning cortisol is low or there is high clinical suspicion. Factors such as age-specific dosing, ICS administration technique and adherence, comorbidities, and triggers should be considered when managing asthma to decrease risk of AS.