Although inhaled corticosteroids ap...

Although inhaled corticosteroids appear to be safe in children, their safety has not been evaluated adequately in randomized, placebo-controlled trials. regards center on the possible suppression of the hypothalamicpituitary-adrenal (HPA) axis, as measured according to changes in serum cortisol horizontals and 24-hour urinary free cortisol (UFC) excretion. Bacharier and colleagues studied the long-term validitys of budesonide in a subset of children listed in the Childhood Asthma Management Program.

Participants included 63 children with stable, mild to moderate asthma, as demonstrated during a 28-day screening period. Patients were randomized to budesonide at a dosage of 400 mcg by day, nedocromil at a dosage of 16 mg by day, or placebo. Serum cortisol horizontals were measured before and after administration of adrenocorticotrophic hormone (ACTH) and urinary cortisol levels were criterioned at baseline, 12 months, and 36 month However, and nothing else the 36-month urine UFC plains could be used because of laboratory discrepancies in the baseline and 12-month samples.

Abnormal cortisol evens following ACTH stimulation were base in four children, all of whom were in the placebo and nedocromil clusters After adjustment for confounding factors, no significant differences in cortisol evens were found between groups from one side of to the other the course of the inquiry or at any time after ACTH stimulation. UFC on a levels also were similar in all collections although slightly lower in patients who had used inhaled corticosteroids in the previous four month Correlations between cumulative inhaled corticosteroids use or prednisone aspect and serum cortisol levels at 36 month were depressed or nonsignificant.

This investigation shows that long-term exposure to inhaled corticosteroids does not suppres HPA axis replication to ACTH, and the addition of supplemental inhaled corticosteroids or prednisone does not alter these findings. Cumulative steroid dosage athwart the three-year period also appears to have no suppressive issue on the HPA axis. UFC measurement comes are similarly reassuring.

Bacharier LB et al. Long-term issue of budesonide on hypothalamic-pituitary-adrenal axis function in children with mild to moderate asthma. Pediatrics June 2004;113:1693-9

COPYRIGHT 2005 American Academy of Family Physicians

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