Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma

This cross-sectional study was designed to examine the prevalence of adrenocortical suppression in children with asthma treated with high-dose inhaled fluticasone propionate (FP). Children and adolescents (n=50) with asthma, treated with inhaled FP at a dose of greater than or equal to1,000 mg a day for greater than or equal to6 months, were enrolled. Early morning serum cortisol was performed. Subjects with a serum cortisol of <400 nmol(.)L(-1) had a tetracosactrin stimulation test. Fifty subjects of mean age 13.1 yrs were treated with a mean dose of 924.7 mug(.)m(-2.)day(-1) FP for a mean duration of 2 yrs. Of the 50 subjects, 36 (72%) had serum cortisol levels of <400 nmol(.)L(-1) and underwent tetracosactrin stimulation test. Of these, 6 (17%) demonstrated a less than two-fold increase in serum cortisol from baseline and peak cortisol level of less than or equal to550 nmol(.)L(-1) at 30 or 60 min poststimulation. There was a significant negative correlation between the dose of FP(.)m(-2) and stimulated peak cortisol level. Biochemical evidence of adrenocortical insufficiency was demonstrated in 12% of the subjects, indicating that high-dose fluticasone propionate use may be associated with dose-dependent adrenocortical suppression.