Strategies to screen for adrenal suppression in children with asthma: there is no consensus among UK centres

In children, inhaled corticosteroids have been proved to be highly effective and it was initially thought that the risk of adrenal suppression was low. 1 As a result, high "off-licence" doses (eg, >=1000 [mu]g/day of fluticasone proprionate) were recommended in difficult cases by national guidelines. 2 The efficacy and safety of such high doses has been seriously questioned by the reporting of around 30 cases of life threatening acute adrenal crisis, including one death, in children maintained on inhaled corticosteroids (largely high dose fluticasone proprionate). 3 Current guidelines therefore caution that doses >=400 [mu]g/day of fluticasone proprionate or equivalent should be prescribed by a specialist who should be aware of the potential for adrenal suppression. 4 A range of tests, varying in invasiveness and complexity, including early morning urinary cortisol, low and high dose synacthen tests and the potentially hazardous insulin-hypoglycaemia test, exist to assess adrenal function in children.