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Effect of Long-term Inhaled Corticosteroids on the Hypothalamic-Pituitary-Adrenal Axis in Children with Asthma

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Abstract

Objectives

To assess the effect of the long-term use of inhaled corticosteroids (ICS) on the hypothalamic-pituitary-adrenal (HPA) axis.

Methods

Children (5–18 y) diagnosed with asthma and on ICS therapy for ≥6 mo were included. In the first step, screening with fasting at 8 AM, cortisol level was measured; a value <15 mcg/dl was considered low. Children with low fasting cortisol levels were subjected to adreno-corticotropic hormone (ACTH) stimulation test in the second step. Post-ACTH stimulation, cortisol level <18 mcg/dl was considered to have HPA axis suppression.

Results

A total of 78 children (males 55, 70.5%) diagnosed with asthma, with a median age of 11.5 (8, 14) y, were enrolled. The median duration of ICS use was 12 (12–24) mo. The median value of post-ACTH stimulation cortisol level was 22.5 (20.6, 25.5) mcg/dl, and a value <18 mcg/dl was observed in 4 (5.1%; 95% CI 0.2–10%) children. There was statistically no significant correlation between low post-ACTH stimulation cortisol level with ICS dose (p = 0.23) and asthma control (p = 0.67). None of the children had clinical features of adrenal insufficiency.

Conclusions

In this study, a few children had low post-ACTH stimulation cortisol values; however, none had clinical evidence of HPA axis suppression. Therefore, ICS is a safe drug in children for treating asthma, even for long-term use.

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Acknowledgements

The authors thank Professor Elizabeth Juniper, McMaster University, for permitting them to use Hindi version of the Asthma Control Questionnaire (ACQ).

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India

    Lekshmi Sambhu Hema, Prawin Kumar, Jagdish Prasad Goyal, Varuna Vyas & Kuldeep Singh

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  1. Lekshmi Sambhu Hema
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  5. Kuldeep Singh
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Contributions

PK & JPG: Conceptualized the idea, conducted a literature search, and prepared the initial manuscript; LSH: Enrolled the patients, did data collection, did a literature search, and wrote the initial draft; VV & KS: Literature search and prepared the initial draft. The manuscript was critically reviewed and approved for publication by all authors. PK will act as a guarantor for this manuscript.

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Correspondence to Prawin Kumar.

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Hema, L.S., Kumar, P., Goyal, J.P. et al. Effect of Long-term Inhaled Corticosteroids on the Hypothalamic-Pituitary-Adrenal Axis in Children with Asthma. Indian J Pediatr 91, 441–447 (2024). https://doi.org/10.1007/s12098-023-04706-6

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  • DOI: https://doi.org/10.1007/s12098-023-04706-6

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