Ninan T K, Reid I W, Carter P E, Smail P J, Russell G
Department of Child Health, University of Aberdeen.
Thorax. 1993 Jun;48(6):599-602. doi: 10.1136/thx.48.6.599.
Childhood asthma generally responds well to inhaled corticosteroids within the dosage range recommended by the manufacturers, but it is sometimes necessary to use higher doses--that is, above 400 micrograms/day--a practice which has become more widespread recently. Whereas the lack of adrenal suppression in children given inhaled corticosteroids in normal doses is well documented, little is known about the effects of higher doses.
The effects on adrenal function of high dose (above 400 micrograms/day) inhaled corticosteroids were evaluated by measuring cortisol concentration in the morning and performing a short tetracosactrin test in 49 children taking budesonide (mean age 9.2 years (range 4 to 16 years) and 28 children taking beclomethasone dipropionate (10.2 years (5 to 13 years)). Twenty three non-asthmatic children (8.9 years (4.9 to 13 years)) who were under investigation for short stature served as controls for the study.
Compared with controls mean basal cortisol concentration was lower in children taking budesonide and beclomethasone dipropionate (control 401 (26.8) nmol/l, budesonide 284 (22) nmol/l, beclomethasone dipropionate 279 (23.2) nmol/l). Sixteen of the 49 children taking budesonide had subnormal basal cortisol concentrations compared with seven of the 28 taking beclomethasone dipropionate. Mean stimulated cortisol concentrations were lower in children taking inhaled corticosteroids than in controls, with no difference between those taking budesonide or beclomethasone dipropionate.
Adrenal suppression occurs in some children who are given inhaled corticosteroids in doses greater than 400 micrograms/day. It may therefore be advisable to try alternative treatments before such doses are used.
儿童哮喘通常对制造商推荐剂量范围内的吸入性糖皮质激素反应良好，但有时有必要使用更高剂量——即每天超过400微克——这种做法近来越来越普遍。虽然正常剂量吸入性糖皮质激素对儿童肾上腺抑制作用缺乏的情况已有充分记录，但对于更高剂量的影响却知之甚少。
通过测量49名服用布地奈德（平均年龄9.2岁（4至16岁））和28名服用二丙酸倍氯米松（10.2岁（5至13岁））儿童早晨的皮质醇浓度，并进行短程二十四肽促皮质素试验，评估高剂量（每天超过400微克）吸入性糖皮质激素对肾上腺功能的影响。23名因身材矮小接受调查的非哮喘儿童（8.9岁（4.9至13岁））作为该研究的对照。
与对照组相比，服用布地奈德和二丙酸倍氯米松的儿童平均基础皮质醇浓度较低（对照组401（26.8）纳摩尔/升，布地奈德284（22）纳摩尔/升，二丙酸倍氯米松279（23.2）纳摩尔/升）。49名服用布地奈德的儿童中有16名基础皮质醇浓度低于正常，而28名服用二丙酸倍氯米松的儿童中有7名。服用吸入性糖皮质激素的儿童平均刺激后皮质醇浓度低于对照组，服用布地奈德或二丙酸倍氯米松的儿童之间无差异。
一些服用超过每天400微克吸入性糖皮质激素的儿童会出现肾上腺抑制。因此，在使用此类剂量之前尝试其他治疗方法可能是明智的。
