Mahachoklertwattana P, Sudkronrayudh K, Direkwattanachai C, Choubtum L, Okascharoen C
Department of Pediatrics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand 10400.
Arch Dis Child. 2004 Nov;89(11):1055-8. doi: 10.1136/adc.2002.020560.
To assess adrenal function in asthmatic children treated with inhaled fluticasone propionate for up to 16 weeks.
Children with asthma and bronchial hyperresponsiveness to inhaled methacholine were treated with inhaled fluticasone 250-750 microg/day via Volumatic spacer. The insulin tolerance test (ITT) was performed to assess adrenal function.
Eighteen asthmatic patients (10 boys, 8 girls), aged 7-17 years received inhaled fluticasone therapy at a median dose of 477 microg/m2 per day for 5-16 weeks. Adrenal suppression, defined as 60 minute serum cortisol less than 500 nmol/l, was found in 9 of 18 children. Following the ITT, the median basal and 60 minute serum cortisol concentrations of the suppressed group were 135.0 and 350.0 nmol/l, respectively; the corresponding values for the unsuppressed group were 242.2 and 564.7 nmol/l. Repeat ITT in the suppressed group 2-3 months after discontinuation of fluticasone revealed that all patients had a 60 minute serum cortisol greater than 500 nmol/l.
After therapy for asthma with inhaled fluticasone at approximately 500 microg daily for up to 16 weeks, half the children had evidence of adrenal suppression.
评估接受吸入丙酸氟替卡松治疗长达16周的哮喘儿童的肾上腺功能。
对患有哮喘且对吸入乙酰甲胆碱有支气管高反应性的儿童，通过Volumatic储雾罐给予250 - 750微克/天的吸入丙酸氟替卡松治疗。进行胰岛素耐量试验（ITT）以评估肾上腺功能。
18例年龄在7 - 17岁的哮喘患者（10名男孩，8名女孩）接受了吸入丙酸氟替卡松治疗，中位剂量为每天477微克/平方米，持续5 - 16周。在18名儿童中，有9名出现肾上腺抑制，定义为60分钟时血清皮质醇低于500纳摩尔/升。ITT后，受抑制组的中位基础血清皮质醇浓度和60分钟时血清皮质醇浓度分别为135.0和350.0纳摩尔/升；未受抑制组的相应值为242.2和564.7纳摩尔/升。在停用氟替卡松2 - 3个月后，对受抑制组进行重复ITT，结果显示所有患者60分钟时血清皮质醇均大于500纳摩尔/升。
在以约500微克/天的剂量吸入丙酸氟替卡松治疗哮喘长达16周后，半数儿童有肾上腺抑制的证据。
