Laura Smy1, Kaitlyn Shaw2, Ursula Amstutz3, Michelle Staub4, Shahnaz Chaudhry5, Anne Smith2, Bruce Carleton6, Gideon Koren7. 1. Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada; Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 2. Child & Family Research Institute, Vancouver, BC, Canada; Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. 3. Child & Family Research Institute, Vancouver, BC, Canada; Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; University Institute of Clinical Chemistry, Inselspital Bern University Hospital, University of Bern, Switzerland. 4. Winnipeg Regional Health Authority, Pharmacy Department, Winnipeg, Manitoba, Canada. 5. Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada. 6. Child & Family Research Institute, Vancouver, BC, Canada; Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, BC, Canada. Electronic address: bcarleton@popi.ubc.ca. 7. Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Maccabi-Kahn Research Institute, Tel Aviv, Israel.
Abstract
BACKGROUND: Inhaled corticosteroids (ICS) are the recommended long-term control therapy for asthma in children. However, concern exists regarding potential adrenal suppression with chronic ICS use. Our pilot study reported that hair cortisol in children was 50% lower during ICS therapy than prior to therapy, suggestive of adrenal suppression. OBJECTIVE: To evaluate hair cortisol concentration (HCC) as a potential biomarker for possible adrenal suppression from ICS use in children with asthma. METHODS: A retrospective observational study was performed at asthma clinics in Vancouver, Winnipeg, and Toronto, Canada. Children (n = 586) were recruited from July 2012 to December 2014 inclusive of those without asthma, with asthma not using ICS, and with asthma using ICS. The most recent three-month HCC was measured by enzyme immunoassay and compared among the groups. Quantile regression analysis was performed to identify factors potentially affecting HCC. RESULTS: The median HCC was not significantly different among the children: No ICS (n = 47, 6.7 ng/g, interquartile range (IQR) 3.7-9.8 ng/g), ICS Treated (n = 360, 6.5 ng/g, IQR 3.8-14.3 ng/g), and Controls (n = 53, 5.8 ng/g, IQR 4.6-16.7 ng/g). 5.6% of the children using ICS had hair cortisol <2.0 ng/g compared to none in the control groups (P < .05, comparing ICS Treated (20/360) to all Controls combined (0/100)) and only half had been exposed to systemic corticosteroids. Age, sex, BMI, and intranasal corticosteroid use were significantly associated with HCC. CONCLUSIONS: Results suggest HCC may be a potential biomarker for adrenal suppression as a population of children using ICS with HCC < 2.0 ng/g was identified compared to none in the control groups. Further research is needed to determine if those children have or are at risk of adrenal suppression or insufficiency.
BACKGROUND: Inhaled corticosteroids (ICS) are the recommended long-term control therapy for asthma in children. However, concern exists regarding potential adrenal suppression with chronic ICS use. Our pilot study reported that hair cortisol in children was 50% lower during ICS therapy than prior to therapy, suggestive of adrenal suppression. OBJECTIVE: To evaluate hair cortisol concentration (HCC) as a potential biomarker for possible adrenal suppression from ICS use in children with asthma. METHODS: A retrospective observational study was performed at asthma clinics in Vancouver, Winnipeg, and Toronto, Canada. Children (n = 586) were recruited from July 2012 to December 2014 inclusive of those without asthma, with asthma not using ICS, and with asthma using ICS. The most recent three-month HCC was measured by enzyme immunoassay and compared among the groups. Quantile regression analysis was performed to identify factors potentially affecting HCC. RESULTS: The median HCC was not significantly different among the children: No ICS (n = 47, 6.7 ng/g, interquartile range (IQR) 3.7-9.8 ng/g), ICS Treated (n = 360, 6.5 ng/g, IQR 3.8-14.3 ng/g), and Controls (n = 53, 5.8 ng/g, IQR 4.6-16.7 ng/g). 5.6% of the children using ICS had hair cortisol <2.0 ng/g compared to none in the control groups (P < .05, comparing ICS Treated (20/360) to all Controls combined (0/100)) and only half had been exposed to systemic corticosteroids. Age, sex, BMI, and intranasal corticosteroid use were significantly associated with HCC. CONCLUSIONS: Results suggest HCC may be a potential biomarker for adrenal suppression as a population of children using ICS with HCC < 2.0 ng/g was identified compared to none in the control groups. Further research is needed to determine if those children have or are at risk of adrenal suppression or insufficiency.
Authors: Marcela Lopez; Monica O Ruiz; Cynthia R Rovnaghi; Grace K-Y Tam; Jitka Hiscox; Ian H Gotlib; Donald A Barr; Victor G Carrion; Kanwaljeet J S Anand Journal: Pediatr Res Date: 2021-01-18 Impact factor: 3.756
Authors: D Gonzalez; P Maidana; Viviana Mesch; B Fabre; C Ibar; J Jamardo; D Jacobsen; A Fritzler; F Fortuna; G Fernandez; E Lamas-Majek; S Mallea-Gil; C Ballarino; C Onetto; M Lopez Journal: Sci Rep Date: 2022-06-20 Impact factor: 4.996
Authors: Esmé J Baan; Erica L T van den Akker; Marjolein Engelkes; Yolanda B de Rijke; Johan C de Jongste; Miriam C J M Sturkenboom; Katia M Verhamme; Hettie M Janssens Journal: Pediatr Pulmonol Date: 2019-10-25