Decreased cortisol response to insulin induced hypoglycaemia in asthmatics treated with inhaled fluticasone propionate.
OBJECTIVE
To assess adrenal function in asthmatic children treated with inhaled fluticasone propionate for up to 16 weeks.


METHODS
Children with asthma and bronchial hyperresponsiveness to inhaled methacholine were treated with inhaled fluticasone 250-750 microg/day via Volumatic spacer. The insulin tolerance test (ITT) was performed to assess adrenal function.


RESULTS
Eighteen asthmatic patients (10 boys, 8 girls), aged 7-17 years received inhaled fluticasone therapy at a median dose of 477 microg/m2 per day for 5-16 weeks. Adrenal suppression, defined as 60 minute serum cortisol less than 500 nmol/l, was found in 9 of 18 children. Following the ITT, the median basal and 60 minute serum cortisol concentrations of the suppressed group were 135.0 and 350.0 nmol/l, respectively; the corresponding values for the unsuppressed group were 242.2 and 564.7 nmol/l. Repeat ITT in the suppressed group 2-3 months after discontinuation of fluticasone revealed that all patients had a 60 minute serum cortisol greater than 500 nmol/l.


CONCLUSIONS
After therapy for asthma with inhaled fluticasone at approximately 500 microg daily for up to 16 weeks, half the children had evidence of adrenal suppression.
Mahachoklertwattana
P
P
Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand 10400. rapmw@mahidol.ac.th
Sudkronrayudh
K
K
Direkwattanachai
C
C
Choubtum
L
L
Okascharoen
C
C
D000280:Administration, Inhalation; D000293:Adolescent; D000311:Adrenal Glands / Q000187:drug effects / Q000503:physiopathology; D000730:Androstadienes / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D000068298:Fluticasone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007328:Insulin; D008297:Male
D000730:Androstadienes; D001993:Bronchodilator Agents; D007328:Insulin; D000068298:Fluticasone; D006854:Hydrocortisone