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Bloodspot cortisol in mild asthma: the effect of inhaled corticosteroids
I J Doull1, S J Donovan, P J Wood
1Southampton General Hospital, Department of University Medicine.
Insights
Bloodspot cortisol testing is effective for monitoring children with asthma at home. Daily inhaled beclomethasone dipropionate significantly lowers daytime cortisol levels in these children.
Area of Science:
- Endocrinology
- Pediatrics
- Respiratory Medicine
Background:
- Bloodspot cortisol analysis offers a convenient method for repeated home-based measurements.
- Inhaled corticosteroids are commonly used in managing childhood asthma.
- The impact of these medications on the natural cortisol rhythm requires further investigation.
Purpose of the Study:
- To evaluate the utility of bloodspot cortisol measurements in children with mild asthma.
- To assess the effect of beclomethasone dipropionate on daytime cortisol concentrations.
Main Methods:
- A double-blind, randomized controlled trial involving 20 children with mild asthma.
- Participants received either placebo or beclomethasone dipropionate (200 micrograms twice daily).
- Home-based finger-prick blood samples were collected at four time points: waking, 1 hour post-treatment, lunchtime, and evening. Area Under the Curve (AUC) was calculated as a composite measure of daytime cortisol.
Main Results:
- Daytime cortisol levels naturally decreased throughout the day in all participants.
- The beclomethasone dipropionate group exhibited significantly lower cortisol levels post-treatment and at lunchtime compared to placebo.
- The calculated AUC for cortisol was significantly reduced in the beclomethasone dipropionate group.
Conclusions:
- Beclomethasone dipropionate, at a daily dose of 400 micrograms, significantly suppresses the daytime cortisol profile in children with mild asthma.
- Bloodspot cortisol monitoring is a viable method for assessing the systemic effects of inhaled corticosteroids in pediatric asthma management.
Abstract:
Bloodspot cortisol, where finger pricked blood is applied to blotting paper, is suitable for repeated measurements in the home environment. The use of bloodspot cortisol measurements in children with asthma and the effect of inhaled corticosteroids on daytime cortisol concentrations were assessed. Twenty children with mild asthma were randomised to receive double blind either placebo or beclomethasone dipropionate 200 micrograms twice daily. Blood was taken by finger prick at home on waking, and treatment administered. Blood was then taken one hour after treatment, at lunchtime, and in the evening. The area under the curve (AUC) for the four time points was calculated as a composite index of daytime cortisol. Mean (SEM) bloodspot cortisols fell progressively over the day from 199.2 (15.6) nmol/l to 58.4 (8.9) nmol/l. Cortisol in the group treated with beclomethasone dipropionate was lower at all time points, but was significant only after treatment (mean (SEM) 120.9 (14.3) v 177.5 (21.0) nmol/l) and at lunchtime (mean (SEM) 82.7 (12.4) v 128.9 (12.6) nmol/l). AUC for the beclomethasone dipropionate treated group was also significantly decreased (mean (SEM) 317 (31.4) v 446 (29.7)). Beclomethasone dipropionate at a dose of 400 micrograms/day significantly suppresses the daytime cortisol profile.