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. 2012 May;17(5):e34-9.
doi: 10.1093/pch/17.5.e34.

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

Ryan W Smith  1 , Kim Downey, Michelle Gordon, Alan Hudak, Rob Meeder, Sarah Barker, W Gary Smith
Affiliations

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

Ryan W Smith et al. Paediatr Child Health. 2012 May.

Abstract
in English, French

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.

Objectif: Déterminer la prévalence de suppression de l’axe hypothalamo-hypophyso-surrénalien (HHA) chez les enfants asthmatiques traités au moyen de corticoïdes par aérosol (CPA).

Méthodologie: Les chercheurs ont obtenu des variables cliniques et démographiques à l’aide de formulaires standardisés préétablis. Ils ont mesuré la suppression de l’axe HHA au moyen de taux de cortisol sérique le matin et l’ont confirmée grâce à un test de stimulation à l’hormone adrénocorticotrope (ACTH) à faible dose.

Résultats: Sur les 214 enfants qui ont participé à l’étude, 20 (9,3 %, 95 % IC 5,3 % à 13,4 %) présentaient une suppression de l’axe HHA. Le risque d’une telle suppression augmentait proportionnellement à la dose de CPA (RRR 1,005, 95 % IC 1,003 à 1,009, P<0,001). Tous les enfants présentant une suppression de l’axe HHA prenaient une dose moyenne à faible de CPA compte tenu de leur âge (200 μg/jour à 500 μg/jour). La suppression de l’axe HHA ne pouvait être prédite selon les caractéristiques cliniques, le type de médicament, la durée de la dose ou l’utilisation concomitante de bêta-agonistes à longue durée d’action ou de stéroïdes par voie nasale.

Conclusion: Il existe des preuves de laboratoire de suppression de l’axe HHA chez les enfants qui prenaient des CPA pour traiter leur asthme. Il faudrait procéder au dépistage régulier de la suppression de l’axe HHA chez des enfants traités au moyen de fortes doses de CPA (plus de 500 μg/jour). Il faut également envisager de dépister les enfants traités au moyen d’une dose moyenne de CPA.

Keywords: Asthma; Hypothalamic-pituitary-adrenal axis; Inhaled corticosteroid.

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Figures

Figure 1)
Figure 1)
Study flow diagram. * ≤170 nmol/L. ACTH adrenocorticotropic hormone
See this image and copyright information in PMC

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