title: CSACI position statement: systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma.
abstract: Asthma is a chronic inflammatory disease of the airways that affects a growing number of children and adolescents. Inhaled corticosteroids (ICS) are the mainstay of treatment in persistent asthma, with a stepwise approach to increasing doses of ICS depending on asthma severity and control. ICS have known local and systemic side effects, of which adrenal suppression is still under-recognized. The latter is associated with chronic exposure and higher doses, although it has rarely been reported in children receiving low doses for a short period of time. The Canadian Society of Allergy and Clinical Immunology (CSACI) therefore recommends that physicians screen for adrenal suppression in children receiving high doses for more than 6 months and to consider screening those on medium dose if the risk is deemed higher by factors that increase an individual's systemic corticosteroid exposure. Morning serum cortisol level can be used as a screening tool and abnormal results or normal results with a high index of suspicion should be confirmed with low-dose ACTH stimulation tests.
authors: Division of Allergy and Immunology, McGill University, 2300 Tupper Street, C-510, Montreal, QC H3H 1P3 Canada.
authors: Karine
authors: K
authors: Issa-El-Khoury
authors: Department of Medicine, Division of Allergy and Immunology, Western University, London, ON Canada ; Department of Medicine, Division of Allergy and Immunology, McMaster University, Hamilton, ON Canada.
authors: Harold
authors: H
authors: Kim
authors: Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada.
authors: Edmond S
authors: ES
authors: Chan
authors: Department of Pediatrics, Division of Clinical Immunology and Allergy, University of Alberta, Edmonton, AB Canada.
authors: Tim
authors: T
authors: Vander Leek
authors: Division of Allergy and Immunology, McGill University, 2300 Tupper Street, C-510, Montreal, QC H3H 1P3 Canada.
authors: Francisco
authors: F
authors: Noya
keywords: Adrenal suppression; Asthma; Fluticasone; Inhaled corticosteroids