Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate.
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.


RESULTS
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.


CONCLUSIONS
When high doses of fluticasone propionate are used, growth may be retarded and adrenal suppression may occur.
Todd
G
G
Antrim Hospital, UK.
Dunlop
K
K
McNaboe
J
J
Ryan
M F
MF
Carson
D
D
Shields
M D
MD
D000287:Administration, Topical; D000302:Adrenal Cortex / Q000187:drug effects*; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003864:Depression, Chemical; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids; D006130:Growth Disorders / Q000139:chemically induced*; D006801:Humans; D008297:Male
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000068298:Fluticasone