ICS use safe in kids with asthma, no evidence of suppression of Hypothalamic-Pituitary-Adrenal Axis

A recent study published in the Indian Journal of Pediatrics has suggested inhaled corticosteroids (ICS) to be a safe drug in children for asthma treatment, even for the long term.

The study showed that a few children had low post-adreno-corticotropic hormone (ACTH) stimulation cortisol value, and none had clinical evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression.

The study was conducted by Prawin Kumar, All India Institute of Medical Sciences (AIIMA), Jodhpur, Rajasthan, India, and colleagues to evaluate the effect of the long-term use of inhaled corticosteroids on the hypothalamic-pituitary-adrenal axis.

The study included children aged 5 to 18 years with asthma diagnosis and n ICS therapy for ≥6 months. Firstly, the screening with fasting was done at 8 AM; cortisol level was measured; <15 mcg/dl value was considered low. In the second step, children with low fasting cortisol were subjected to ACTH stimulation. Post-ACTH stimulation, cortisol level <18 mcg/dl was considered to have HPA axis suppression.

In the study, the researchers enrolled 78 children (males 55, 70.5%) diagnosed with asthma, with a median age of 11.5 years. The median duration of ICS use was 12 months.

The study led to the following findings:

• The median value of post-ACTH stimulation cortisol level was 22.5 mcg/dl, and a value <18 mcg/dl was observed in 4 children.
• There was statistically no significant correlation between low post-ACTH stimulation cortisol level with ICS dose and asthma control.
• None of the children had clinical features of adrenal insufficiency.

"Our results showed that a few children had low post-ACTH stimulation cortisol values; however, none had clinical evidence of HPA axis clinical suppression," the researchers wrote. "Therefore, even for long-term use, ICS is a safe drug in children for treating asthma."

Reference:

Hema, L.S., Kumar, P., Goyal, J.P. et al. Effect of Long-term Inhaled Corticosteroids on the Hypothalamic-Pituitary-Adrenal Axis in Children with Asthma. Indian J Pediatr (2023). https://doi.org/10.1007/s12098-023-04706-6