title: Salivary cortisol levels in prepubertal children using inhaled corticosteroids with or without concurrent intranasal corticosteroids.
abstract: BACKGROUND
  Inhaled corticosteroids (ICS) and intranasal steroids (INS) are frequently co-administered in children with asthma and rhinitis. In contrast to monotherapy with ICS or INS, little is known about the safety of concurrent use of topical steroids on hypothalamic-pituitary-adrenal (HPA) axis function in prepubertal children.
  
  
  OBJECTIVE
  Comparison of morning salivary cortisol levels in prepubertal children using maintenance treatment with ICS with and without concurrent use of INS to steroid naïve control groups (healthy children, and children with constipation who are under pediatric care).
  
  
  METHODS
  Cross-sectional observational study in prepubertal children (6-12 years) using ICS alone (n = 41) or in combination with INS (n = 22), compared to different control groups with no steroid treatment (18 healthy children, and 28 children with constipation). Morning salivary cortisol levels were determined from saliva samples collected at home.
  
  
  RESULTS
  The morning salivary cortisol levels of the healthy children (8.7 nmol/L; 95% CI 5.9-18.8), and the children with constipation (8.9 nmol/L; 8.0-11.3) were comparable. The salivary cortisol levels of prepubertal children using ICS (median 4.7 nmol/L; 95% CI 4.6-6.9) or a combination of ICS and INS (5.1 nmol/L; 4.2-7.6) were comparable, but significantly reduced compared to both control groups. There was no correlation between salivary cortisol level and age, duration of disease, or cumulative daily dose of topical steroids.
  
  
  CONCLUSIONS
  Salivary cortisol levels in prepubertal children using ICS, with or without concurrent use of INS, were comparable. However, salivary cortisol levels were significantly reduced compared to steroid naïve controls, irrespective of the cumulative daily dose of topical steroids. Pediatr. Pulmonol. 2011; 46:1055-1061. © 2011 Wiley Periodicals, Inc.
authors.affiliation: Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Sigrid M
authors.initials: SM
authors.lastname: Heijsman
authors.forename: Tjalling W
authors.initials: TW
authors.lastname: de Vries
authors.forename: Albert
authors.initials: A
authors.lastname: Wolthuis
authors.forename: Arvid W A
authors.initials: AW
authors.lastname: Kamps
mesh_terms: D000280:Administration, Inhalation; D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002648:Child; D003248:Constipation / Q000150:complications; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000188:drug therapy*; D012463:Saliva / Q000737:chemistry*; D012469:Salivary Glands / Q000378:metabolism*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D006854:Hydrocortisone