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Adrenal suppression among asthmatic children receiving chronic therapy with inhaled corticosteroid with and without
1Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Inhaled corticosteroids for asthma can cause adrenal suppression in children. Using a spacer device with metered dose inhalers significantly reduces this risk compared to direct inhalation.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
Background:
- Inhaled corticosteroids (ICS) are a primary treatment for chronic asthma in children.
- ICS therapy can impact the hypothalamic-pituitary-adrenal (HPA) axis in pediatric patients.
Purpose of the Study:
- To determine the incidence of adrenal suppression in children with asthma on low to moderate dose ICS.
- To compare the effects of beclomethasone dipropionate delivered via metered dose inhaler (MDI) versus MDI with a spacer device (MDI-spacer).
Main Methods:
- 39 asthmatic children on chronic ICS therapy (≥4 months) were studied.
- Patients received beclomethasone dipropionate via MDI (n=15) or MDI-spacer (n=24).
- 21 healthy children served as controls; 24-hour urinary free cortisol excretion was measured.
Main Results:
- Adrenal suppression (reduced cortisol excretion) was found in 47% of MDI users versus 8% of MDI-spacer users (P = .006).
- Mean 24-hour urinary free cortisol was lower in the MDI group compared to MDI-spacer and control groups.
- No significant difference in cortisol excretion was observed between MDI-spacer and control groups.
Conclusions:
- Chronic use of low to moderate dose inhaled corticosteroids is linked to adrenal suppression in some children with asthma.
- Adrenal suppression is more prevalent with direct MDI use.
- Utilizing a large volume spacer with an MDI decreases the frequency of this side effect.
Background:
Inhaled corticosteroids have become a first-line treatment for chronic asthma. It has been shown that inhaled corticosteroids can have a measurable effect on the hypothalamic-pituitary-adrenal axis in asthmatic children.
Objective:
To investigate the prevalence of adrenal suppression among asthmatic children receiving chronic therapy with low to moderate doses (up to 1000 micrograms) of inhaled beclomethasone dipropionate via a metered dose inhaler (MDI) and via MDI attached to a spacer device (MDI-spacer).
Methods:
The study included 39 asthmatic children currently undergoing therapy; 24 received beclomethasone dipropionate by MDI attached to a spacer, and 15 directly by MDI. All the patients had been treated for at least 4 months. Another 21 children were normal controls. The 24-hour urinary free cortisol excretion was measured to evaluate hypothalamic-pituitary-adrenal axis function.
Results:
Seven of 15 (47%) patients from the MDI group had reduced 24 hour-urinary free cortisol excretion and 2 of 24 (8%) in the MDI-spacer group (P = .006). The mean 24-hour urinary free cortisol excretion of the MDI group was 0.0185 +/- 0.0089 microgram/gram creatinine, and the MDI-spacer and the control groups were, 0.0290 +/- 0.0138 microgram/gram creatinine and 0.0270 +/- 0.0118 microgram/gram creatinine, respectively, (P = 0.37, f = 3.51 ANOVA).
Conclusion:
Chronic inhalation of low to moderate doses of corticosteroids is associated with adrenal suppression in some asthmatic children. This side effect is more common among patients inhaling directly from the MDI and is less frequent when a large volume spacer is attached to the MDI.