Decreased morning serum cortisol levels in children with asthma treated with inhaled fluticasone propionate

Nemr Eid, Ronald Morton, Bradley Olds, Pamela Clark, Shahid Sheikh, Stephen Looney

Research output: Contribution to journalArticle

53 Scopus citations

Abstract

Objective. In an observational long-term study, we followed 62 children (37 males, 25 females; mean age: 11.6 ± 2.9 years) with moderate-to-severe asthma for 2 years and studied the effects of fluticasone propionate (176-1320 μg/day) on the function of the hypothalamic-pituitary-adrenal axis. Study Design. Morning cortisol levels were monitored after patients had been on fluticasone for a mean of 8.0 ± 5.2 months. Patients who had abnormal low morning cortisol levels (< 5.5 μg/dL) were then switched either to lower fluticasone dosage or to other inhaled steroid formulation. Exact methods based on the binomial distribution were used to construct a 95% confidence interval for the true proportion of abnormal readings among those treated, and the Wilcoxon signed rank test was used to test for a significant difference between cortisol levels taken before and after the switch. Results. Twenty-two patients (36%) had abnormal morning cortisol levels while on fluticasone. Of the patients on a low dose (176 μg/day), 17% had abnormal values, whereas 43% of patients on a high dose (≥880 μ/day) were abnormal. Patients with abnormal results (17/22) had their morning cortisol levels repeated 3 months after the switch. Thirteen of these patients (77%) had normal levels. A stratified analysis of the difference in morning cortisol levels before and after the switch showed significant increase in morning cortisol levels in the group receiving 440 μg/day or less of fluticasone (median difference: 5.25; confidence interval: 3.60-8.15), as well as in the group receiving 440 μg/day or more (median difference: 3.85; confidence interval: 1.00-7.60). Conclusion. Inhaled fluticasone, even at conventional doses, may have greater effects on the adrenal function than previously recognized, but the clinical significance of this suppression still remains to be established.

Original languageEnglish (US)
Pages (from-to)217-221
Number of pages5
JournalPediatrics
Volume109
Issue number2 I
DOIs
StatePublished - Feb 16 2002
Externally publishedYes

Keywords

  • Asthma
  • Fluticasone propionate
  • Inhaled fluticasone
  • Morning cortisol levels

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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