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[Adrenal cortex function in children with bronchial asthma in fluticasone therapy]
A Hoffmann-Streb1, D L'Allemand, B Niggemann
1Universitäts-Kinderklinik (KAVH), Berlin.
Summary
Inhaled Fluticasone and Budesonide do not suppress the pituitary-adrenocortical axis in children with asthma. Oral prednisone, however, showed significant adrenal suppression, indicating inhaled steroids are a safer asthma treatment option.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Asthma management in children often involves corticosteroids.
- Concerns exist regarding the potential for systemic absorption and adverse effects of inhaled corticosteroids (ICS) on the hypothalamic-pituitary-adrenal (HPA) axis.
- Fluticasone is a newer inhaled steroid used for asthma treatment.
Purpose of the Study:
- To evaluate the impact of inhaled Fluticasone on the pituitary-adrenocortical axis in pediatric asthma patients.
- To compare the effects of Fluticasone and Budesonide with oral prednisone on adrenal function.
Main Methods:
- Investigated 7 children (7-15 years) treated with Fluticasone (100-200 mcg/day) before and during treatment.
- Assessed circadian cortisol secretion and hCRH-stimulation-test in children treated with Fluticasone and 7 others on Budesonide (800 mcg/day).
- Compared results with 4 children receiving oral prednisone (2.5-7.5 mg/day).
Main Results:
- Inhaled Fluticasone at tested dosages did not suppress adrenal function.
- Budesonide treatment also showed no evidence of adrenocortical suppression.
- Oral prednisone therapy resulted in marked suppression of adrenocortical function, even at low doses.
Conclusions:
- Inhaled Fluticasone and Budesonide, at the dosages studied, are safe for treating pediatric asthma.
- These inhaled steroids do not appear to significantly impact the pituitary-adrenocortical axis in children.
- Oral prednisone demonstrates a higher risk of HPA axis suppression compared to inhaled alternatives.