title: Prevalence of hypothalamic-pituitary-adrenal axis suppression in children treated for asthma with inhaled corticosteroid.
abstract: OBJECTIVE
  To determine the prevalence of hypothalamic-pituitary-adrenal (HPA) axis suppression in asthmatic children on inhaled corticosteroids (ICS).
  
  
  METHODS
  Clinical and demographic variables were recorded on preconstructed, standardized forms. HPA axis suppression was measured by morning serum cortisol levels and confirmed by low-dose adrenocorticotropic hormone stimulation testing.
  
  
  RESULTS
  In total, 214 children participated. Twenty children (9.3%, 95% CI 5.3% to 13.4%) had HPA axis suppression. Odds of HPA axis suppression increased with ICS dose (OR 1.005, 95% CI 1.003 to 1.009, P<0.001). All children with HPA axis suppression were on a medium or lower dose of ICS for their age (200 μg/day to 500 μg/day). HPA axis suppression was not predicted by drug type, dose duration, concomitant use of long-acting beta-agonist or nasal steroid, or clinical features.
  
  
  CONCLUSIONS
  Laboratory evidence of HPA axis suppression exists in children taking ICS for asthma. Children should be regularly screened for the presence of HPA axis suppression when treated with high-dose ICS (>500 μg/day). Consideration should be given to screening children on medium-dose ICS.
authors: Department of Medicine and Health, University College Cork, Cork, Ireland;
authors: Ryan W
authors: RW
authors: Smith
authors: Kim
authors: K
authors: Downey
authors: Michelle
authors: M
authors: Gordon
authors: Alan
authors: A
authors: Hudak
authors: Rob
authors: R
authors: Meeder
authors: Sarah
authors: S
authors: Barker
authors: W Gary
authors: WG
authors: Smith
keywords: Asthma; Hypothalamic-pituitary-adrenal axis; Inhaled corticosteroid
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