Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Indian J Pediatr. 2024 May;91(5):441-447. doi: 10.1007/s12098-023-04706-6. Epub 2023 Jul 7.
To assess the effect of the long-term use of inhaled corticosteroids (ICS) on the hypothalamic-pituitary-adrenal (HPA) axis.
Children (5-18 y) diagnosed with asthma and on ICS therapy for ≥6 mo were included. In the first step, screening with fasting at 8 AM, cortisol level was measured; a value <15 mcg/dl was considered low. Children with low fasting cortisol levels were subjected to adreno-corticotropic hormone (ACTH) stimulation test in the second step. Post-ACTH stimulation, cortisol level <18 mcg/dl was considered to have HPA axis suppression.
A total of 78 children (males 55, 70.5%) diagnosed with asthma, with a median age of 11.5 (8, 14) y, were enrolled. The median duration of ICS use was 12 (12-24) mo. The median value of post-ACTH stimulation cortisol level was 22.5 (20.6, 25.5) mcg/dl, and a value <18 mcg/dl was observed in 4 (5.1%; 95% CI 0.2-10%) children. There was statistically no significant correlation between low post-ACTH stimulation cortisol level with ICS dose (p = 0.23) and asthma control (p = 0.67). None of the children had clinical features of adrenal insufficiency.
In this study, a few children had low post-ACTH stimulation cortisol values; however, none had clinical evidence of HPA axis suppression. Therefore, ICS is a safe drug in children for treating asthma, even for long-term use.
评估长期使用吸入性皮质类固醇（ICS）对下丘脑-垂体-肾上腺（HPA）轴的影响。
纳入诊断为哮喘且接受 ICS 治疗≥6 个月的儿童。在第一步，空腹 8 点时进行皮质醇水平筛查；皮质醇值<15mcg/dl 被认为是低的。第二步，对空腹皮质醇水平较低的儿童进行促肾上腺皮质激素（ACTH）刺激试验。ACTH 刺激后，皮质醇水平<18mcg/dl 被认为存在 HPA 轴抑制。
共纳入 78 名（男性 55 名，70.5%）诊断为哮喘、中位年龄 11.5（8，14）岁的儿童。ICS 使用的中位时间为 12（12-24）个月。ACTH 刺激后皮质醇水平的中位数为 22.5（20.6，25.5）mcg/dl，4 名（5.1%；95%CI 0.2-10%）儿童的皮质醇水平<18mcg/dl。ACTH 刺激后皮质醇水平低与 ICS 剂量（p=0.23）和哮喘控制（p=0.67）之间无统计学显著相关性。无儿童出现肾上腺皮质功能不全的临床特征。
在这项研究中，少数儿童 ACTH 刺激后皮质醇值较低；然而，无儿童存在 HPA 轴抑制的临床证据。因此，ICS 是治疗儿童哮喘的一种安全药物，即使长期使用也是如此。
