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

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 <500 nmol/L 30 minutes after low-dose adrenocorticotropin test.
• 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.