OBJECTIVE: To determine the prevalence of hypothalamic-pituitary-adrenal (HPA) axis suppression in asthmatic children on inhaled corticosteroids (ICS). METHODS: Clinical and demographic variables were recorded on preconstructed, standardized forms. HPA axis suppression was measured by morning serum cortisol levels and confirmed by low-dose adrenocorticotropic hormone stimulation testing. RESULTS: In total, 214 children participated. Twenty children (9.3%, 95% CI 5.3% to 13.4%) had HPA axis suppression. Odds of HPA axis suppression increased with ICS dose (OR 1.005, 95% CI 1.003 to 1.009, P<0.001). All children with HPA axis suppression were on a medium or lower dose of ICS for their age (200 μg/day to 500 μg/day). HPA axis suppression was not predicted by drug type, dose duration, concomitant use of long-acting beta-agonist or nasal steroid, or clinical features. CONCLUSION: Laboratory evidence of HPA axis suppression exists in children taking ICS for asthma. Children should be regularly screened for the presence of HPA axis suppression when treated with high-dose ICS (>500 μg/day). Consideration should be given to screening children on medium-dose ICS.
OBJECTIVE: To determine the prevalence of hypothalamic-pituitary-adrenal (HPA) axis suppression in asthmatic children on inhaled corticosteroids (ICS). METHODS: Clinical and demographic variables were recorded on preconstructed, standardized forms. HPA axis suppression was measured by morning serum cortisol levels and confirmed by low-dose adrenocorticotropic hormone stimulation testing. RESULTS: In total, 214 children participated. Twenty children (9.3%, 95% CI 5.3% to 13.4%) had HPA axis suppression. Odds of HPA axis suppression increased with ICS dose (OR 1.005, 95% CI 1.003 to 1.009, P<0.001). All children with HPA axis suppression were on a medium or lower dose of ICS for their age (200 μg/day to 500 μg/day). HPA axis suppression was not predicted by drug type, dose duration, concomitant use of long-acting beta-agonist or nasal steroid, or clinical features. CONCLUSION: Laboratory evidence of HPA axis suppression exists in children taking ICS for asthma. Children should be regularly screened for the presence of HPA axis suppression when treated with high-dose ICS (>500 μg/day). Consideration should be given to screening children on medium-dose ICS.
Authors: Maaike P Smit; Ed H G van Leer; Gerard Noppe; Yolanda B de Rijke; Dieneke Kramer van Driel; Erica L T van den Akker Journal: Horm Res Paediatr Date: 2017-07-14 Impact factor: 2.852
Authors: H Philpott; M K Dougherty; C C Reed; M Caldwell; D Kirk; D J Torpy; E S Dellon Journal: Aliment Pharmacol Ther Date: 2018-03-05 Impact factor: 8.171
Authors: Priyadarshini Kachroo; Isobel D Stewart; Rachel S Kelly; Meryl Stav; Kevin Mendez; Amber Dahlin; Djøra I Soeteman; Su H Chu; Mengna Huang; Margaret Cote; Hanna M Knihtilä; Kathleen Lee-Sarwar; Michael McGeachie; Alberta Wang; Ann Chen Wu; Yamini Virkud; Pei Zhang; Nicholas J Wareham; Elizabeth W Karlson; Craig E Wheelock; Clary Clish; Scott T Weiss; Claudia Langenberg; Jessica A Lasky-Su Journal: Nat Med Date: 2022-03-21 Impact factor: 87.241