Normal diurnal variation in serum cortisol concentration in asthmatic children treated with inhaled budesonide.
BACKGROUND
Twenty-four-hour serum cortisol secretion is a sensitive parameter for the assessment of the pituitary-adrenal function of asthmatic children treated with inhaled corticosteroids. This study was undertaken to determine the effect of the long-term administration of inhaled budesonide on 24-hour cortisol production in young children with asthma.


METHODS
We studied 11 children, aged 7 to 12 years, with severe perennial asthma. All had been receiving 100 micrograms of inhaled budesonide twice daily, administered with a spacer device, for 3 to 5 years. Serum cortisol concentration was measured at 8:00 A.M., 60 minutes after intravenous administration of 0.25 mg of corticotropin, and every 30 minutes for 24 hours in an open-design study. Urinary cortisol secretion was measured by 24-hour urine collection. All determinations were made with a radioimmunoassay kit.


RESULTS
The individual morning serum cortisol concentration and the serum cortisol concentration at 60 minutes after corticotropin stimulation were within normal limits in all children. The 24-hour urinary cortisol excretion was also normal. The individual 24-hour serum cortisol concentration showed a normal pattern in all children, with no evidence of nocturnal suppression of serum cortisol concentration.


CONCLUSIONS
Prolonged (3 to 5 years) administration of 200 micrograms/day of inhaled budesonide in young children with severe asthma does not impair pituitary-adrenal function, even according to the sensitive test for 24-hour serum cortisol secretion.
Department of Pediatrics C, Children's Medical Center of Israel, Petah Tiqva, Israel.
B
B
Volovitz
A
A
Kauschansky
M
M
Nussinovitch
L
L
Harel
I
I
Varsano
D000280:Administration, Inhalation; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide; D002648:Child; D002940:Circadian Rhythm / Q000276:immunology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D008297:Male; D011282:Pregnenediones / Q000008:administration & dosage / Q000627:therapeutic use*
D001993:Bronchodilator Agents; D011282:Pregnenediones; D019819:Budesonide; D006854:Hydrocortisone