Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

Santiago, Angela H.; Ratzan, Susan

doi:10.1155/2010/749239

Cited by 10 publications

(6 citation statements)

References 18 publications

(25 reference statements)

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“…When exogenous glucocorticoids significantly alter the pattern of normal diurnal variation in cortisol levels adverse consequences are expected [12]. Acute adrenal insufficiency was seen less commonly compared to adrenal suppression shown by laboratory tests [13].…”

Section: Discussionmentioning

confidence: 99%

Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma

et al. 2019

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BackgroundInhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. However adverse effects of ICS on Hypothalamo Pituitary Adrenal (HPA) axis, growth and bone metabolism are a concern. Hence the primary objective of this study was to describe the effects of long term inhaled corticosteroid therapy (ICS) on adrenal function, growth and bone health in children with asthma in comparison to an age and sex matched group of children with asthma who were not on long term ICS. Describing the association between the dose of ICS and duration of therapy on the above parameters were secondary objectives.MethodSeventy children with asthma on ICS and 70 controls were studied. Diagnosis of asthma in selected patients was reviewed according to the criteria laid down by GINA 2018 guidelines. The estimated adult heights were interpreted relative to their Mid Parental Height (MPH) range. Serum calcium, alkaline phosphatase and vitamin D levels were analyzed in both groups and cortisol value at 30 min following a low dose short synacthen test was obtained from the study group. The average daily dose of ICS (Beclamethasone) was categorized as low, medium and high (100–200, 200–400, > 400 μg /day) respectively according to published literature.ResultsHeights of all children were within the MPH range. There was no statistically significant difference in the bone profiles and vitamin D levels between the two groups (Ca: p = 0.554, vitamin D: p = 0.187) but vitamin D levels were insufficient (< 50 nmol/l) in 34% of cases and 41% of controls. Suppressed cortisol levels were seen in 24%. Doses of ICS were low, medium and high in 56, 32 and 12% of children respectively. The association between adrenal suppression with longer duration of therapy (p < 0.01) and with increasing dose of ICS (p < 0.001) were statistically significant.ConclusionICS had no impact on the growth and bone profiles but its dose and duration were significantly associated with adrenal suppression.

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Section: Discussionmentioning

confidence: 99%

Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma

et al. 2019

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“…Despite a near doubling of the AUCs with the AeroChamber Plus® versus the Babyhaler®, adrenal suppression at a FP dose of 176 µg·day −1 (which is considered a low dose) [5, 39] is unlikely, except in a minority of patients [24, 25, 40–45]. It is possible that as airway obstruction improves, there will be greater lung delivery [46, 47] and potentially greater systemic effects, as changes in serum cortisol are dose-dependent [48, 49].…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, noted decreases in serum cortisol or urinary cortisol excretion do not appear to translate into observable clinical adverse effects (reduced growth rate or ocular effects) with use at this dose (or an equivalent dose of other ICSs) for ≥1 yr [40, 41]. However, individual sensitivity to these effects has been observed [25, 44, 45]. In addition, a pharmacokinetic/pharmacodynamic model developed to define the relationship between systemic exposures (in cortisol equivalents) and changes in growth velocity, determined that no effect on growth velocity would be predicted with either VHC at the dose of FP used in this study [38].…”

Section: Discussionmentioning

confidence: 99%

Bioavailability of inhaled fluticasone propionate via chambers/masks in young children

Blake

Mehta

Spencer³

et al. 2011

European Respiratory Journal

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We determined lung bioavailability of a fluticasone propionate (FP) pressurised metred-dose inhaler (Flovent® HFA; GlaxoSmithKline, Research Triangle Park, NC, USA) administered via AeroChamber Plus® (Monaghan Medical, Plattsburgh, NY, USA) with Facemask and Babyhaler® (GlaxoSmithKline) valved holding chambers (VHCs) using a population pharmacokinetic approach. Children from 1 to <4 yrs of age with stable asthma but a clinical need for inhaled corticosteroid therapy were administered 88 µg FP hydrofluoroalkane (2 × 44 µg) twice daily delivered through the two devices in an open-label, randomised crossover manner for 8 days each. Patients were randomised to one of three sparse sampling schedules for blood collection throughout the 12-h dosing interval on the 8th day of each treatment for pharmacokinetic analysis. The area under the FP plasma concentration–time curve (AUC) was determined for each regimen. 17 children completed the study. The population mean AUC following FP with AeroChamber Plus® with Facemask was 97.45 pg·h·mL−1 (95% CI 85.49–113.32 pg·h·mL−1) and with Babyhaler® was 51.55 pg·h·mL−1 (95% CI 34.45–64.46 pg·h·mL−1). The relative bioavailability (Babyhaler®/AeroChamber Plus®) was 0.53 (95% CI 0.30–0.75). Clinically significant differences in lung bioavailability were observed between the devices. VHCs are not interchangeable, as differences in drug delivery to the lung may occur. A population pharmacokinetic approach can be used to determine lung bioavailability of FP.

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“…Acute adrenal insufficiency was seen less commonly compared to adrenal suppression shown by laboratory tests (13). In a survey conducted in UK ,33 patients (28 children, 5 adults) were identified to have adrenal crisis.…”

Section: Ics and Adrenal Suppressionmentioning

confidence: 99%

Effect Of Long Term Inhaled Corticosteroid Therapy On Adrenal Suppression, Growth And Bone Health In Children With Asthma

Anuradha

Prematilake

Batuwita

et al. 2019

Preprint

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EFFECT OF LONG TERM INHALED CORTICOSTEROID THERAPY ON ADRENAL SUPPRESSION, GROWTH AND BONE HEALTH IN CHILDREN WITH ASTHMA Anuradha KWDA1, Prematilake GLDC2, Batuwita BAUI3, Kannangoda KASR4, Hewagamage US5,Wijeratne S6, Lankatilake Kantha7, de Silva KSH8 Abstract Background Primary objective was to describe the effect of long term inhaled corticosteroid therapy (ICS) on adrenal suppression, growth and bone health in children with Asthma. Secondary objectives were to describe the association between the dose of ICS and duration of therapy on adrenal functions, growth and bone health in children with asthma, describe their growth ,biochemical parameters associated with bone health and vitamin D levels in comparison to an age and sex matched group of children with asthma who were not on long term ICS. Method Seventy children with asthma on ICS and 70 controls were studied. The estimated adult heights were interpreted relative to their Mid Parental Height (MPH) range. Serum calcium, alkaline phosphatase and vitamin D levels were assayed in both groups and cortisol value at 30 minutes following a low dose short synacthen test was obtained from the study group. The average daily dose of ICS was categorized as low, medium and high (100-200, 200-400, >400 ug /day ) respectively according to published literature. Results Heights of all children were within the MPH range. There was no statistically significant difference in the bone profiles and vitamin D levels between the two groups (Ca: p=0.554, vitamin D: p=0.187) but vitamin D levels were insufficient (<50 nmol/l) in 34% of cases and 41% of controls. Suppressed cortisol levels were seen in 24%. Doses of ICS were low, medium and high in 56%, 32% and 12% of children respectively. The association between adrenal suppression with longer duration of therapy (p<0.01) and with increasing dose of ICS (p<0.001) were statistically significant. Conclusion ICS had no impact on the growth and bone profiles but its dose and duration were significantly associated with adrenal suppression. Key Words- Asthma, Inhaled corticosteroids, Growth, Adrenal suppression, Bone Metabolism, Vitamin D

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Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

Cited by 10 publications

References 18 publications

Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma

Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma

Bioavailability of inhaled fluticasone propionate via chambers/masks in young children

Effect Of Long Term Inhaled Corticosteroid Therapy On Adrenal Suppression, Growth And Bone Health In Children With Asthma

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