Evidence of hypothalamic-pituitary-adrenal axis suppression during moderate-to-high-dose inhaled corticosteroid use


Cavkaytar Ö. , Vuralli D., Yilmaz E. A. , Buyuktiryaki B., UYSAL SOYER Ö., ŞAHİNER Ü. M. , ...More

EUROPEAN JOURNAL OF PEDIATRICS, vol.174, no.11, pp.1421-1431, 2015 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 174 Issue: 11
  • Publication Date: 2015
  • Doi Number: 10.1007/s00431-015-2610-9
  • Title of Journal : EUROPEAN JOURNAL OF PEDIATRICS
  • Page Numbers: pp.1421-1431
  • Keywords: Adverse effect, Asthma, Hypothalamic-pituitary-adrenal axis, Low-dose ACTH stimulation test, Treatment, ADRENOCORTICOTROPIC HORMONE ACTH, ASTHMATIC-CHILDREN, INTRANASAL CORTICOSTEROIDS, NASAL CORTICOSTEROIDS, MANAGEMENT, TESTS, FLUTICASONE, CICLESONIDE, BUDESONIDE, EFFICACY

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 mu g/day fluticasone propionate-hydrofluoroalkane (FP-HFA) for patients 0-11 and a parts per thousand yen12 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 mu g/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 a parts per thousand yen22 mu g 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 mu g/day FP (area under the curve (AUC) = 0.840, p = 0.003) for predicting HPA-AS