Asthma: long-term, high-dose ICS linked to adrenal suppression in children

  • Kwda A & al.
  • BMC Pediatr
  • 5 Nov 2019

  • International Clinical Digest
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Takeaway

  • A cohort study finds an association between long-term, high-dose inhaled corticosteroids (ICS) and adrenal suppression in paediatric asthma, but no adverse effects on growth or bone health.

Why this matters

  • Clinicians are encouraged to use the lowest possible dose of ICS for paediatric asthma.

Study design

  • Cross-sectional cohort of 70 children with asthma on ICS vs 70 age- and sex-matched children with asthma not on long-term ICS.
  • Height was estimated relative to mid parental height.
  • Adrenal suppression was defined as peak cortisol level
  • Funding: No external funds.

Key results

  • No differences between groups on height, vitamin D, and serum calcium levels, and slightly higher median serum alkaline phosphatase in the long-term ICS group (225 vs 198.5 U/L in the non-long-term ICS group; P<.01>
  • In the long-term ICS group, 24.3% (17/70) had adrenal suppression, and the following relationships were observed:
    • Longer duration of use (>24 months) was associated with higher rates of adrenal suppression (P<.01>
    • High-dose ICS (>400 μg/day) was associated with higher rates of adrenal suppression (P<.01>

Limitations

  • Small sample sizes.
  • Children under study may not be representative of all children with asthma.
  • Observational design.