Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
Allergy Asthma Proc. 2010 Jan-Feb;31(1):10-9. doi: 10.2500/aap.2010.31.3305.
Corticosteroids are the foundation of pharmacologic treatment for children with asthma. However, high-dose inhaled corticosteroid treatment can cause hypothalamic-pituitary-adrenal (HPA) axis suppression. We investigated the effect of three doses of mometasone furoate administered via dry-powder inhaler (MF-DPI) on the HPA axis in children. Fifty children (6-11 years) with mild asthma of > or =6 months' duration were randomized to MF-DPI, 100 (n = 13), 200 (n = 13), or 400 micrograms b.i.d. (n = 12), or placebo (n = 12) for 29 days. The primary end point was change from baseline in the 12-hour area under the plasma-cortisol-concentration-time curve (AUC). Secondary parameters included plasma cortisol response to cosyntropin stimulation and 24-hour urinary free cortisol concentrations. Compared with placebo, AUC changes associated with treatments of MF-DPI, 100 or 200 micrograms b.i.d., were not significant, whereas a significant change was observed with MF-DPI, 400 micrograms b.i.d. (27%; p = 0.05). Responses to cosyntropin stimulation and urinary cortisol measurements were similar to placebo with all MF-DPI doses. All regimens were well tolerated. MF-DPI did not have a significant effect on plasma or urinary cortisol levels at doses up to 200 micrograms b.i.d. in children with mild asthma. Higher MF-DPI doses may potentially suppress the HPA axis.
皮质类固醇是儿童哮喘药物治疗的基础。然而，大剂量吸入皮质类固醇治疗可引起下丘脑-垂体-肾上腺（HPA）轴抑制。我们研究了通过干粉吸入器（MF-DPI）给予三种剂量的糠酸莫米松对儿童 HPA 轴的影响。50 名（6-11 岁）轻度哮喘持续时间≥6 个月的儿童随机分为 MF-DPI，100（n=13）、200（n=13）或 400 微克，bid（n=12）或安慰剂（n=12），治疗 29 天。主要终点是基线时血浆皮质醇浓度-时间曲线（AUC）的 12 小时面积的变化。次要参数包括促皮质素刺激后的血浆皮质醇反应和 24 小时尿游离皮质醇浓度。与安慰剂相比，MF-DPI、100 或 200 微克，bid 的 AUC 变化无显著性差异，而 MF-DPI、400 微克，bid 的 AUC 变化显著（27%；p=0.05）。促皮质素刺激和尿皮质醇测量的反应与所有 MF-DPI 剂量的安慰剂相似。所有方案均耐受良好。MF-DPI 在儿童中，低至 200 微克，bid 的剂量对血浆或尿皮质醇水平没有显著影响。较高剂量的 MF-DPI 可能会潜在地抑制 HPA 轴。
