oa Current Allergy & Clinical Immunology - Effects of corticosteroids on adrenal function in children with asthma : review article

Volume 27, Issue 4
  • ISSN : 1609-3607



Undoubtedly Inhaled Corticosteroids (ICS) and, to a lesser extent, nasal steroids (NS) have revolutionised therapy and improved quality of life in a cost-effective way for every asthma patient. Prior to 1972, only oral corticosteroids (OCS), usually prednisone, were used to treat asthma whenever non-steroid therapy was ineffective. Prednisone, however, is four times as potent as hydrocortisone (HC) or its natural equivalent, cortisol (C) and therefore potentially more likely to suppress the hypothalamic-pituitaryadrenal axis (HPA). This was proven in a small study of 11 asthmatic children, who were given prednisone at 2 mg/kg/day in three divided doses for 5 days. Three days after the course was completed an insulin tolerance test (ITT) was performed which showed that all, but two, failed to have an adequate C response. Ten days after termination of therapy the axis had recovered in all patients. In spite of its limitations, this study demonstrated how easily the HPA can be suppressed by supra-physiological doses of OCS within a relatively short time. Given a lapse of OCS therapy with an additional exposure to stress, such as infection or trauma, adrenal crisis may thus be a distinct possibility.

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