Adrenal Function Improves in Asthmatic Children on Inhaled Steroids: A Longitudinal Study

Abstract

Background/Aims: Asthmatic children on long-term treatment with inhaled corticosteroids (ICS) may exhibit mild adrenal suppression. We aimed to test the hypothesis that baseline adrenal function of some asthmatic children might be lower than that of others and that this difference might be accentuated by ICS therapy. Methods: A low-dose Synacthen test was performed in 41 prepubertal asthmatic children placed on long-term inhaled budesonide (400 µg/day) prior to the onset of ICS treatment, 6 and 12 months later. Five children withdrew before the 6- and another 2 before the 12-month follow-up. Results: Low adrenal function was demonstrated in 4 children (9.8%) upon recruitment and in another 8 at the 6-month evaluation (22.2%). Adrenal function normalized in the aforementioned 4 children at the 6-month evaluation, while 6 (17.6%) exhibited suppressed adrenal function at the 12-month evaluation. Three of these patients had also exhibited adrenal suppression at the 6-month visit. A significant improvement in peak cortisol values from baseline to the 6- and 12-month evaluation (95% confidence intervals: –283.9 to –69.0 and –239.8 to –50.8, respectively) was evident when children with suppressed adrenal response at the second or third evaluation were excluded. Conclusions: In many asthmatic children, adrenal response improves on long-term ICS. The expected adrenal suppression of certain patients on maintenance ICS appears to constitute a separate phenomenon.

Association of Hypothalamic-Pituitary-Adrenal Axis-Related Polymorphisms with Stress in Asthmatic Children on Inhaled Corticosteroids

“…Before starting any ICS treatment, 3.2% of our cohort had low adrenal reserve which subsequently improved. This finding is in line with the study of Priftis et al [22] who demonstrated that ICS as anti-inflammatory agents might have favorable effects in asthmatics with subnormal adrenal responses at baseline. Only 4.5% of our cohort showed low adrenal reserve after ICS treatment, confirming the safety of ICS when they are used in low to moderate doses [23] .…”

Lower cortisol levels in children with asthma exposed to recurrent maternal distress from birth

“…Inhaled corticosteroid medications were used predominantly in children with asthma, not those without (38.8% vs 3.5%, respectively; P < .0001), but the inhaled route of administration has been reported to have inconsistent systemic effects in children. 24,25 Important to our analysis, the percentage use of corticosteroid medication did not vary by maternal distress category within children with asthma (P 5 .72). Finally, although cortisol levels were available in 507 of the 723 SAGE children, these children did not differ from the overall case-control study in terms of the percentage of children who had asthma 10 ; the distribution of maternal distress categories also was similar to that for the complete birth cohort of 14,000 children.…”

Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis

“…There are groups who report potential baseline abnormalities on ACTH stimulation testing in children with asthma. Priftis et al [52] found that approximately 10% of children aged 2–6 years with allergic asthma show an abnormal cortisol response to stress even though the basal salivary cortisol level is similar to that in controls. While baseline HPA axis abnormalities in pediatric AD patients have not been studied as extensively as in asthmatic children, the potential for abnormal baseline HPA axis function was considered outside the scope of the current study and children were excluded if their pre-treatment ACTH stimulation testing was abnormal.…”