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

CAVKAYTAR O. , VURALLİ D., Yilmaz E. A. , Buyuktiryaki B., Soyer O., ŞAHİNER Ü. M. , ...Daha Fazla

EUROPEAN JOURNAL OF PEDIATRICS, cilt.174, sa.11, ss.1421-1431, 2015 (SCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 174 Konu: 11
  • Basım Tarihi: 2015
  • Doi Numarası: 10.1007/s00431-015-2610-9
  • Sayfa Sayıları: ss.1421-1431


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