Adrenal function improves in asthmatic children on inhaled steroids: a longitudinal study.
OBJECTIVE
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 microg/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.
Priftis
Kostas N
KN
Department of Allergy and Pneumonology, P. Penteli Children's Hospital, Penteli, Greece. kpriftis@otenet.gr
Papadimitriou
Anastasios
A
Anthracopoulos
Michael B
MB
Gatsopoulou
Evi
E
Fretzayas
Andrew
A
Nicolaidou
Polyxeni
P
Chrousos
George P
GP
D000280:Administration, Inhalation; D000284:Administration, Oral; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000276:immunology* / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects / Q000276:immunology; D012075:Remission, Spontaneous; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D013995:Time; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013256:Steroids; D019819:Budesonide; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D006854:Hydrocortisone