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: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.1590/1806-9282.63.10.899 http://hdl.handle.net/1843/57565 https://orcid.org/0000-0003-3089-655X |
Resumo: | 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 hypothalamicpituitary-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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2023-08-07T19:42:25Z2023-08-07T19:42:25Z2017-05-026310899903https://doi.org/10.1590/1806-9282.63.10.8990104-4230http://hdl.handle.net/1843/57565https://orcid.org/0000-0003-3089-655XIntroduction: 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 hypothalamicpituitary-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.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAMED - DEPARTAMENTO DE PEDIATRIARevista da Associação Médica BrasileiraAsmaCorticosteroidesSupressãoCriançaAsthmaCorticosteroidsSuppressionChildOral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://www.scielo.br/pdf/ramb/v63n10/0104-4230-ramb-63-10-0899.pdfCristina Botelho BarraMaria Jussara Fernandes FontesMarco Túlio Gualberto CintraJanaina Andrade GuimarãesM.c.c. GuimarãesRenata Campos da CruzIvani Novato Silvaapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/57565/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALOral corticosteroids for asthma exacerbations might be associated with adrenal suppression Are physicians aware of that pdfa.pdfOral corticosteroids for asthma exacerbations might be associated with adrenal suppression Are physicians aware of that pdfa.pdfapplication/pdf111095https://repositorio.ufmg.br/bitstream/1843/57565/2/Oral%20corticosteroids%20for%20asthma%20exacerbations%20might%20be%20associated%20with%20adrenal%20suppression%20Are%20physicians%20aware%20of%20that%20pdfa.pdfb5c25f1319e395ecb20004a8b1d5a306MD521843/575652023-08-07 17:03:08.085oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-08-07T20:03:08Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.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? Cristina Botelho Barra Asthma Corticosteroids Suppression Child Asma Corticosteroides Supressão Criança |
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 |
Cristina Botelho Barra |
author_facet |
Cristina Botelho Barra Maria Jussara Fernandes Fontes Marco Túlio Gualberto Cintra Janaina Andrade Guimarães M.c.c. Guimarães Renata Campos da Cruz Ivani Novato Silva |
author_role |
author |
author2 |
Maria Jussara Fernandes Fontes Marco Túlio Gualberto Cintra Janaina Andrade Guimarães M.c.c. Guimarães Renata Campos da Cruz Ivani Novato Silva |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Cristina Botelho Barra Maria Jussara Fernandes Fontes Marco Túlio Gualberto Cintra Janaina Andrade Guimarães M.c.c. Guimarães Renata Campos da Cruz Ivani Novato Silva |
dc.subject.por.fl_str_mv |
Asthma Corticosteroids Suppression Child |
topic |
Asthma Corticosteroids Suppression Child Asma Corticosteroides Supressão Criança |
dc.subject.other.pt_BR.fl_str_mv |
Asma Corticosteroides Supressão Criança |
description |
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 hypothalamicpituitary-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.issued.fl_str_mv |
2017-05-02 |
dc.date.accessioned.fl_str_mv |
2023-08-07T19:42:25Z |
dc.date.available.fl_str_mv |
2023-08-07T19:42:25Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/57565 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.1590/1806-9282.63.10.899 |
dc.identifier.issn.pt_BR.fl_str_mv |
0104-4230 |
dc.identifier.orcid.pt_BR.fl_str_mv |
https://orcid.org/0000-0003-3089-655X |
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https://doi.org/10.1590/1806-9282.63.10.899 http://hdl.handle.net/1843/57565 https://orcid.org/0000-0003-3089-655X |
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0104-4230 |
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eng |
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eng |
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Revista da Associação Médica Brasileira |
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info:eu-repo/semantics/openAccess |
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openAccess |
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Universidade Federal de Minas Gerais |
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UFMG |
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Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CLÍNICA MÉDICA MED - DEPARTAMENTO DE PEDIATRIA |
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Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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