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Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate
Insights
High-dose fluticasone propionate in children with severe asthma may cause growth retardation and adrenal suppression. Reducing the dose can restore normal growth and cortisol response.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
Background:
- Fluticasone propionate, an inhaled corticosteroid, was introduced as a safer alternative.
- Established efficacy and safety at 200 µg/day, but not at higher doses commonly used.
Observation:
- Growth retardation observed in six children with severe asthma on high-dose fluticasone propionate (dry powder).
- Cortisol response assessed via insulin-induced hypoglycemia, short/low-dose tetracosactrin tests, and urinary cortisol/creatinine ratio.
Findings:
- Six children with growth retardation showed adrenal suppression after high-dose fluticasone propionate treatment.
- One child's growth and cortisol response normalized after reducing fluticasone dose to 500 µg/day.
Implications:
- High-dose fluticasone propionate may impede growth and cause adrenal suppression in pediatric asthma patients.
- Monitoring and dose adjustment are crucial for managing inhaled corticosteroid therapy in children.
Background:
Fluticasone propionate was introduced in 1993 in the UK as a potentially safer inhaled corticosteroid than those already in use. The efficacy and safety of fluticasone has been established at recommended doses of 200 micrograms/day, but not at higher doses that are often used.
Methods:
Growth retardation was observed in six severely asthmatic children after introduction of high-dose fluticasone propionate treatment (dry powder). Assessment of cortisol response was by insulin-induced hypoglycaemia in three cases, by short tetracosactrin test in two, and by low-dose tetracosactrin and 24-hour urinary cortisol/creatinine ratio in one.
Findings:
Six children with growth retardation noted after treatment with high-dose fluticasone propionate were found to have adrenal suppression. In one case the growth rate and cortisol response returned to normal 9 months after the fluticasone dose was reduced to 500 micrograms/day.
Interpretation:
When high doses of fluticasone propionate are used, growth may be retarded and adrenal suppression may occur.