Hypothalamic-Pituitary-Adrenal Axis Suppression in Asthmatic School Children

Zöllner, Ekkehard Werner; Lombard, Carl; Galal, Ushma; Hough, F. S.; Irusen, E M; Weinberg, Eugene

doi:10.1542/peds.2012-1147

Cited by 80 publications

(89 citation statements)

References 26 publications

(25 reference statements)

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“…Systemic adverse effects such as growth suppression and local effects including oropharyngeal candidiasis are well recognised in association with ICS [4][5][6][7]. With recent pragmatic studies showing greater adherence to, and effectiveness of, LTRA compared to ICS [8][9][10], the prospect of increased adherence resulting in better asthma control has renewed interest in the use of LTRA as monotherapy or adjunct therapy.…”

Section: Introductionmentioning

confidence: 99%

“…With recent pragmatic studies showing greater adherence to, and effectiveness of, LTRA compared to ICS [8][9][10], the prospect of increased adherence resulting in better asthma control has renewed interest in the use of LTRA as monotherapy or adjunct therapy. Montelukast, the only LTRA licensed for use in children aged <12 years appears to be generally well tolerated with side-effects primarily limited to minor gastrointestinal disturbances, respiratory symptoms, skin reactions and headaches [11]; importantly, the absence of growth and adrenal suppression [5] increases its appeal for children with asthma. With similar drug effectiveness in the real-life setting, safety profiles and acceptability become key elements to guide the choice between ICS and LTRA monotherapy and LTRA versus long-acting β 2 -adrenoceptor agonists (LABA) as adjunct therapy in children with asthma.…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

et al. 2017

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@ERSpublicationsThe incidence of children on montelukast with drug cessation due to neuropsychiatric adverse events was >10% http://ow.ly/nCGG30bgjpd ABSTRACT Although montelukast is generally well tolerated, postmarketing studies have reported serious neuropsychiatric adverse drug reactions (ADRs) leading to a United States Food and Drug Administration black box warning. The objective of this study was to determine the incidence of neuropsychiatric ADRs leading to discontinuation of montelukast in asthmatic children.We conducted a retrospective cohort study in children aged 1-17 years initiated on montelukast. In a nested cohort study, children initiated on montelukast as monotherapy or adjunct therapy to inhaled corticosteroids (ICS) were matched to those initiated on ICS monotherapy. A non-leading parental interview served to ascertain the occurrence of any ADRs with any asthma medication, and circumstances related to, and evolution of, the event.Out of the 106 participants who initiated montelukast, most were male (58%), Caucasian (62%) with a median (interquartile range) age of 5 (3-8) years. The incidence (95% CI) of drug cessation due to neuropsychiatric ADRs was 16 (10-26)%, mostly occurring within 2 weeks. Most frequent ADRs were irritability, aggressiveness and sleep disturbances. The relative risk of neuropsychiatric ADRs associated with montelukast versus ICS was 12 (2-90).In the real-life setting, asthmatic children initiated on montelukast experienced a notable risk of neuropsychiatric ADRs leading to drug cessation, that is significantly higher than that associated with ICS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

et al. 2017

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“…Height growth may be reduced by ∼0.5-2 cm during the first 1-2 years of treatment; whether or not this persists over time is under debate but cannot be excluded [183][184][185]. Adrenal suppression is more frequently seen during treatment with high-dose ICS; however, the frequency and severity of hypothalamic-pituitary-adrenal axis suppression is highly dependent on the tests used to assess this axis, and one should be aware that adrenal insufficiency may occur at low-to-moderate doses of ICS [186,187]. More research is needed to define which tests for adrenal suppression are useful in which children.…”

Section: Side-effects Of Drug Treatmentmentioning

confidence: 99%

Monitoring asthma in children

et al. 2015

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The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence. @ERSpublications ERS statement summarising and discussing the available literature on monitoring children with asthma

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“…15,16,27 Surprisingly, the most reliable predictors of AS described in asthmatic children are related to clinical features such as low body mass for age, 28 decreased lung function and poor symptom control. 29 Impaired adrenal function in asthmatic children was believed to contribute to the development of more severe asthma, but current data suggest that asthma itself may down regulate the HPA activity so that ICS treatment may actually improve adrenal function in well-controlled patients. 30 In our series, biochemical adrenal suppression was resolved in a short period during follow-up both by controlling asthma symptoms with inhaled corticosteroid treatment and by ceasing systemic drug treatments.…”

Section: Discussionmentioning

confidence: 97%

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

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et al. 2017

Rev. Assoc. Med. Bras.

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Hypothalamic-Pituitary-Adrenal Axis Suppression in Asthmatic School Children

Abstract: Two-thirds of children on corticosteroids may have hypothalamic-pituitary-adrenal axis dysfunction. In one-third, central function had recovered but adrenal suppression persisted. Predictive factors for HPAS are NS use, BMI, and adherence to ICS and NS.

Cited by 80 publications

References 26 publications

Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

Neuropsychiatric adverse drug reactions in children initiated on montelukast in real-life practice

Monitoring asthma in children

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

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