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Endocrine and lung function in asthmatic children on inhaled corticosteroids
W H Nicolaizik1, J L Marchant, M A Preece
1Paediatric Respiratory Department, Royal Brompton National Heart and Lung Hospitals, London, United Kingdom.
American Journal of Respiratory and Critical Care Medicine
|September 1, 1994
Summary
Low-dose inhaled corticosteroids like beclomethasone dipropionate (BDP) and budesonide (BUD) significantly reduce cortisol levels in children with asthma. These inhaled corticosteroids also improve lung function without significant differences between BDP and BUD.
Area of Science:
- Pediatric Pulmonology
- Endocrinology
- Pharmacology
Background:
- The safety and systemic effects of inhaled corticosteroids (ICS) in pediatric asthma management are crucial considerations.
- Concerns exist regarding potential adrenal suppression with ICS therapy, even at low doses.
Purpose of the Study:
- To evaluate the systemic safety and efficacy of two low-dose inhaled corticosteroids, beclomethasone dipropionate (BDP) and budesonide (BUD), in children with chronic asthma.
- To compare the effects of BDP and BUD on adrenal function and lung function parameters.
Main Methods:
- A prospective, randomized crossover study involving 12 children with inadequately controlled asthma.
- Participants received BDP and BUD (200 mcg twice daily) for 2 weeks each, with home monitoring of symptoms and peak expiratory flow.
- Assessment included overnight serum cortisol, ACTH, growth hormone sampling, 24-h urine free cortisol, and detailed lung function tests before and after each treatment period.
Main Results:
- Both BDP and BUD significantly suppressed nocturnal serum cortisol (27-35%) and 24-h urinary free cortisol (33-48%) after 2 and 4 weeks of treatment, with no significant difference between the drugs.
- Adrenocorticotropic hormone (ACTH) and growth hormone levels remained unchanged.
- Significant improvements in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow rates (FEF50, FEF25) were observed with both treatments, with minimal clinical differences between BDP and BUD.
Conclusions:
- Low-dose inhaled corticosteroids (BDP and BUD) demonstrate systemic effects, evidenced by adrenal suppression, in children with asthma.
- Despite systemic effects, both BDP and BUD effectively improve lung function in pediatric asthma.
- The findings underscore the importance of using the minimum effective dose of inhaled corticosteroids to balance asthma control and minimize systemic side effects.