Long-Term Cortisol Concentration in Scalp Hair of Asthmatic Children Using Inhaled Corticosteroids: A Case-Control Study

Abstract

Introduction: Inhaled corticosteroids (ICS) can interfere with the hypothalamic-pituitary-adrenal (HPA) axis and may lead to adrenal insufficiency, resulting in a decrease of cortisol production. Cortisol levels measured in scalp hair provide a marker for long-term cortisol exposure. Data regarding hair cortisol concentration (HCC) in asthmatic children with ICS therapy are scarce. The aim of this study is to compare HCC in asthmatic children under ICS treatment with a healthy control group. Methods: We set up a case-control study measuring the cortisol concentration in scalp hair in asthmatic children (N = 80) treated with ICS and healthy controls (N = 252) aged 4–18 years. Anthropometric characteristics and hair samples from the posterior vertex were obtained. At least 5 mg of the most proximal 3 cm of hair was used for each hair sample. HCC was analyzed by liquid chromatography-tandem mass spectrometry. Results: HCC did not significantly differ between asthmatic children using ICS and healthy controls (p = 0.950) after adjustment for age, gender, height, body mass index, and socioeconomic status. No correlation was found between budesonide dosage and HCC levels (r = –0.031, p = 0.78). Conclusion: There was no evidence of suppression of basal cortisol production, as measured in scalp hair, in asthmatic children using ICS, compared to healthy controls. No conclusions can be drawn on the HPA-axis stress response in these children.

Hair cortisol and inhaled corticosteroid use in asthmatic children

“…We measured the association between ICS and HCC in chronic ICS users who had been using ICS for a period of at least 2 years. Like in our study, Smit et al investigated the effect of ICS dose on HCC in a cross‐sectional design including 80 asthmatic children, and also did not see a significant dose effect. We observed that the median HCC was lower by increasing ICS dose categories (low, medium, and high) but this difference in median HCC did not reach statistical significance probably because of low numbers, especially of patients using high dose ICS, and the variety in sensitivity to glucocorticosteroids.…”

“…The samples were sent to the Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands. The samples were processed and analyzed as described previously . The proximal 3 cm of hair were used for analyses.…”

“…The samples were processed and analyzed as described previously. 13,17 The proximal 3 cm of hair were used for analyses. As hair grows on average about 1 cm per month, 3 cm relates to the cortisol production during the 3 months before hair sample collection.…”

“…There are few studies investigating the association between HCC and ICS, and these show conflicting results. However, sample sizes were small with few patients taking high dose ICS while especially these patients are at risk of adrenal insufficiency . In this cross‐sectional observational study, we measured and compared HCC between asthmatic and nonasthmatic children.…”

“…However, sample sizes were small with few patients taking high dose ICS while especially these patients are at risk of adrenal insufficiency. [12][13][14] In this crosssectional observational study, we measured and compared HCC between asthmatic and nonasthmatic children. Additionally, the association between ICS dose and HCC was investigated.…”