Children with asthma have significantly lower long‐term cortisol levels in their scalp hair than healthy children

Kamps, Arvid W A; Molenmaker, Marco; Kemperman, Ramses F. J.; Veen, Betty S. van der; Bocca, Gianni; Veeger, Nic J. G. M.

doi:10.1111/apa.12685

Cited by 32 publications

(32 citation statements)

References 27 publications

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“…The results of a recent study analyzing hair cortisol in children with asthma receiving ICS were similar to our findings with reported cortisol levels twofold lower than those in children without asthma (24). However, it was unknown whether the decrease in cortisol was due to the inflammatory condition itself or due to the effect of ICS.…”

Section: Resultssupporting

confidence: 89%

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

et al. 2015

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Background: Asthma is the most common chronic condition in childhood, and the recommended pharmacotherapy for long-term control includes the use of inhaled corticosteroids (ICS). ICS were designed to act at the site of inflammation in the lung, thus decreasing systemic absorption and reducing the risk of adverse effects associated with corticosteroid use (e.g., HPA suppression and its consequent effects). Available data show that measurement of hair cortisol successfully reflects endogenous cortisol levels. We sought to examine whether hair cortisol measurements can be used to identify HPA suppression surrounding ICS therapy in children with asthma. Methods: Hair samples were collected from the vertex posterior region of the head of 18 asthmatic children. We compared their hair cortisol concentration during ICS use with the concentration prior to ICS use. results: During ICS therapy, median hair cortisol levels were twofold lower compared with the period of no ICS use (median 89.8 ng/g vs. 198.2 ng/g, P = 0.0015). conclusion: Hair cortisol is an effective biomarker of the HPA suppression associated with ICS therapy and can be a sensitive tool for determining systemic effects of ICS use and monitoring adherence. Future research is needed to characterize the effect of untreated asthma on hair cortisol concentrations, if any.

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Section: Resultssupporting

confidence: 89%

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

et al. 2015

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“…Two pilot case-control studies similar to the present study have been published [20, 21]. In contrast to our finding, Kamps et al [20] concluded that HCC in asthmatic children treated with ICS (median 2.0 pg/mg; 95% CI 1.4–4.1) was “significantly” lower than HCC in healthy children (4.3 pg/mg; 95% CI 1.8–5.9, p value not reported). Of note, while markedly different means are reported, the distribution of HCC of both the asthmatic and the control group completely overlap.…”

Section: Discussionmentioning

confidence: 99%

“…Studies regarding HCC in asthmatic children with ICS therapy are scarce [20, 21]. The aim of this case-control study was to compare long-term cortisol concentrations in scalp hair of asthmatic children receiving ICS treatment with those of healthy children.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Therefore, reduced ACTH levels in CF children may be a sign of both hyperand hypocortisolaemia associated with the abnormal driving of the hypothalamic-pituitary-adrenal (HPA) axis by repeated lung disease exacerbations and chronic systemic low-grade inflammation [36] . While impaired adrenal response and HPA axis exhaustion are well documented in asthma and non-CF bronchiectasis [37][38][39] , similar findings in CF patients have been limited. To our knowledge, only the recent study by Laguna et al [40] has demonstrated decreased plasma cortisol concentrations in CF patients (aged 13.6-38.5 years) during acute pulmonary exacerbations.…”

Section: Discussionmentioning

confidence: 99%

Steady-State Therapy with Azithromycin or Low-Dose Prednisolone in Paediatric Cystic Fibrosis Patients: Inflammatory Markers and Disease Progression

Shmarina

Pukhalsky²,

Avakian³

et al. 2017

Int Arch Allergy Immunol

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Background: Anti-inflammatory therapy is a logical approach to slowing the inevitable lung function deterioration in cystic fibrosis (CF) patients. This study's aim was to evaluate inflammatory markers and disease progression in paediatric CF patients chronically treated with azithromycin or low-dose prednisolone. Methods: The study included 204 patients with CF and 100 healthy controls; 102 CF patients were treated with basic therapy only (without anti-inflammatory treatment; WAT), and 102 individuals received basic therapy along with azithromycin (n = 59) or low-dose prednisolone (n = 43). The median duration of therapy was 24 months (range 12-82) with azithromycin and 31 months (range 12-180) with prednisolone. A cross-sectional analysis of plasma and sputum biomarkers was performed. Results: Compared with the healthy controls, the WAT group showed elevated IFN-γ, IL-10 (total), and TGFβ₁ concentrations, and decreased TNFα (total) and adrenocorticotropic hormone (ACTH) levels (all p < 0.05). Plasma TNFα (total) concentrations in azithromycin/prednisolone patients were significantly higher than those in WAT patients and similar to those of healthy children. In contrast, IL-10 (total) levels were significantly decreased in azithromycin/prednisolone-treated patients compared with WAT patients. Children from the azithromycin group demonstrated ACTH levels similar to those of healthy controls. Azithromycin-treated patients showed a significantly reduced rate of CF-related liver disease and a significantly increased incidence of glucose metabolism disturbances. Conclusions: Steady-state anti-inflammatory treatments may have a sustained immunomodulatory action at systemic and local levels in CF patients. Further investigations are needed to assess the effects of supportive azithromycin therapy on the hypothalamic-pituitary-adrenal axis and the incidence of non-pulmonary CF complications.

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Children with asthma have significantly lower long‐term cortisol levels in their scalp hair than healthy children

Abstract: Long-term cortisol levels were significantly lower in children with asthma than healthy children. Measuring long-term cortisol levels in scalp hair is an attractive, noninvasive tool that can evaluate the effect of asthma and its treatment on the hypothalamic-pituitary-adrenal axis.

Cited by 32 publications

References 27 publications

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children

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

Steady-State Therapy with Azithromycin or Low-Dose Prednisolone in Paediatric Cystic Fibrosis Patients: Inflammatory Markers and Disease Progression

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