Erschienen in:
01.11.2015 | Original Article
Evidence of hypothalamic-pituitary-adrenal axis suppression during moderate-to-high-dose inhaled corticosteroid use
verfasst von:
Ozlem Cavkaytar, Dogus Vuralli, Ebru Arik Yilmaz, Betul Buyuktiryaki, Ozge Soyer, Umit M. Sahiner, Nurgun Kandemir, Bulent E. Sekerel
Erschienen in:
European Journal of Pediatrics
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Ausgabe 11/2015
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Abstract
The possible risk of adverse effects due to regular use of inhaled corticosteroids (ICS) is a real concern. Our aim was to describe the factors that have an impact on hypothalamic-pituitary-adrenal axis suppression (HPA-AS) in children and adolescents taking ICS regularly. The HPA axis status of patients who were on moderate-to-high-dose ICS [>176 and >264 μg/day fluticasone propionate-hydrofluoroalkane (FP-HFA) for patients 0–11 and ≥12 years, respectively] was investigated. Various types of ICS were converted to FP-HFA equivalent according to National Asthma Education and Prevention Program (NAEPP) guidelines. Participants with a baseline (8 a.m.) serum cortisol <15 μg/dL underwent a low-dose ACTH stimulation test (LDAT) to diagnose HPA-AS. Among 91 patients, 60 (75.9 %) participants underwent LDAT, and seven (7.7, 95 % CI 3.5–15.3 %) were diagnosed with HPA-AS. Ciclesonide was more frequently used by the participants with HPA-AS compared to patients with a normal HPA axis (42.9 vs. 4.8 %, p = 0.009). Use of ICS at moderate-to-high doses for at least 7 months distinguished participants with HPA-AS from those with a normal HPA axis. Among the duration, type, and dose of ICS, solely the use of ICS with a body mass index (BMI)-adjusted daily dose of ≥22 μg FP was found to increase the risk for HPA-AS (odds ratio (OR) 7.22, 95 % confidence interval (CI) 1.23–42.26, p = 0.028). The receiver operating characteristics (ROC) curve analysis revealed a cutoff value of 291 μg/day FP (area under the curve (AUC) = 0.840, p = 0.003) for predicting HPA-AS
Conclusion: The prevalence of HPA-AS was found to be 7.7 % in children taking not only high-dose ICS but also moderate-dose ICS. Dose alone was found to be an actual risk factor for HPA-AS.
What is Known:
• Inhaled corticosteroids are the current mainstay treatment for persistent asthma.
• The possible risk of systemic side effects due to regular consumption of inhaled corticosteroids (ICS) is a frequent issue of concern for both physicians and parents of patients in the pediatric age group.
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What is New:
• The prevalence of hypothalamic-pituitary-adrenal axis suppression was 7.7 % in a group of children taking inhaled corticosteroids not only at high but also at moderate doses.
• Among the duration, type, and dose of inhaled corticosteroids, only the use of fluticasone propionate equivalent metered-dose inhaler at a body mass index-adjusted daily dose of ≥22 μg was found to increase the risk for hypothalamic-pituitary-adrenal axis suppression.
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