Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista da Associação Médica Brasileira (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001000899 |
Resumo: | Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing. |
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Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?asthmacorticosteroidssuppressionchildSummary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.Associação Médica Brasileira2017-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001000899Revista da Associação Médica Brasileira v.63 n.10 2017reponame:Revista da Associação Médica Brasileira (Online)instname:Associação Médica Brasileira (AMB)instacron:AMB10.1590/1806-9282.63.10.899info:eu-repo/semantics/openAccessBarra,Cristina B.Fontes,Maria Jussara F.Cintra,Marco Túlio G.Cruz,Renata C.Rocha,Janaína A. G.Guimarães,Maíla Cristina C.Silva,Ivani Novatoeng2017-12-11T00:00:00Zoai:scielo:S0104-42302017001000899Revistahttps://ramb.amb.org.br/ultimas-edicoes/#https://old.scielo.br/oai/scielo-oai.php||ramb@amb.org.br1806-92820104-4230opendoar:2017-12-11T00:00Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)false |
dc.title.none.fl_str_mv |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
title |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
spellingShingle |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? Barra,Cristina B. asthma corticosteroids suppression child |
title_short |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
title_full |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
title_fullStr |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
title_full_unstemmed |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
title_sort |
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? |
author |
Barra,Cristina B. |
author_facet |
Barra,Cristina B. Fontes,Maria Jussara F. Cintra,Marco Túlio G. Cruz,Renata C. Rocha,Janaína A. G. Guimarães,Maíla Cristina C. Silva,Ivani Novato |
author_role |
author |
author2 |
Fontes,Maria Jussara F. Cintra,Marco Túlio G. Cruz,Renata C. Rocha,Janaína A. G. Guimarães,Maíla Cristina C. Silva,Ivani Novato |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Barra,Cristina B. Fontes,Maria Jussara F. Cintra,Marco Túlio G. Cruz,Renata C. Rocha,Janaína A. G. Guimarães,Maíla Cristina C. Silva,Ivani Novato |
dc.subject.por.fl_str_mv |
asthma corticosteroids suppression child |
topic |
asthma corticosteroids suppression child |
description |
Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-10-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001000899 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001000899 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/1806-9282.63.10.899 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Associação Médica Brasileira |
publisher.none.fl_str_mv |
Associação Médica Brasileira |
dc.source.none.fl_str_mv |
Revista da Associação Médica Brasileira v.63 n.10 2017 reponame:Revista da Associação Médica Brasileira (Online) instname:Associação Médica Brasileira (AMB) instacron:AMB |
instname_str |
Associação Médica Brasileira (AMB) |
instacron_str |
AMB |
institution |
AMB |
reponame_str |
Revista da Associação Médica Brasileira (Online) |
collection |
Revista da Associação Médica Brasileira (Online) |
repository.name.fl_str_mv |
Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB) |
repository.mail.fl_str_mv |
||ramb@amb.org.br |
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1754212832980762624 |