Repeatability of the low-dose ACTH test in asthmatic children on inhaled corticosteroids.
OBJECTIVE
To assess the repeatability of low-dose Synacthen test (LDST) in asthmatic children receiving high-dose fluticasone propionate (FP).


METHODS
Low-dose Synacthen test was performed on 18 children with stable chronic asthma treated with FP at a constant daily dose of > or =500 microg and repeated 1 month later. Repeatability was assessed using the Kappa statistic for categorical variables.


RESULTS
Fifteen patients had consistent results (either two normal or two abnormal responses) and three patients had inconsistent results (one normal and one abnormal response). The Kappa statistic was 0.56 indicating fair to good agreement between the tests.


CONCLUSIONS
The results of adrenal function testing in patients on inhaled steroids can have major implications for patient management, making it important to use a test with excellent repeatability. The LDST conducted using our protocol does not fulfil this criterion.
Gupta
Atul
A
Department of Respiratory Paediatrics, Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
Cheetham
Tim
T
Jaffray
Clare
C
Ullman
Denise
D
Gibb
Ian
I
Spencer
David A
DA
D000280:Administration, Inhalation; D000293:Adolescent; D000304:Adrenal Cortex Function Tests / Q000379:methods*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis; D000730:Androstadienes / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D003366:Cosyntropin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D000068298:Fluticasone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D015203:Reproducibility of Results
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003366:Cosyntropin; C006418:adrenocorticotropin zinc; D000068298:Fluticasone; D006854:Hydrocortisone