Prevalence of hypothalamic-pituitary-adrenal axis suppression in children treated for asthma with inhaled corticosteroids

PDF / Free    Original Articles (Online only) May 2012, Volume 17 Issue 5: e 34-e 39 Prevalence of hypothalamic-pituitary-adrenal axis suppression in children treated for asthma with inhaled corticosteroids RW Smith, K Downey, M Gordon, A Hudak, R Meeder, S Barker, WG Smith 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. Conclusion: 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.