Effects of nebulized corticosteroids therapy on hypothalamic-pituitary-adrenal axis in young children with recurrent or persistent wheeze
Inhaled corticosteroids (ICS) are preferred drugs for the long‐term treatment of all severities of asthma in children. However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this...
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Veröffentlicht in: | Pediatric allergy and immunology 2008-12, Vol.19 (8), p.773-776 |
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creator | Cetinkaya, Feyzullah Kayiran, Petek Memioglu, Nihal Tarim, Omer Faruk Eren, Nezaket Erdem, Ela |
description | Inhaled corticosteroids (ICS) are preferred drugs for the long‐term treatment of all severities of asthma in children. However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this study, the effects of nebulized budesonide and nebulized fluticasone propionate suspensions on hypothalamic–pituitary–adrenal axis is examined in infants with recurrent or persistent wheeze. Thirty‐one children aged 6–24 months admitted to our hospital between January and December 2005 with symptoms of recurrent or persistent wheeze were included in the study. The patients were randomly allocated to receive 0.25 mg BUD or 0.25 mg fluticasone propionate twice daily for 6 wk and half dose for another 6 wk with a jet nebulizer at home. Blood samples for basal cortisol concentration, adrenocarticotropic hormone, glucose, HbA1c and electrolytes were obtained at the beginning and at the end of the study. Adrenal function assessment was based on changes in cosyntropin‐stimulated plasma cortisol levels. The study was completed with 31 patients, 16 of whom received BUD and 15 FP. All patients except one had plasma cortisol concentrations above 500 nmol/l (18 μg/dl) or had an incremental rise in cortisol of >200 nmol/l after stimulation. Although nebulized steroids seem to be safe in infancy, we recommend that adrenal functions should be tested periodically during long‐term treatment with nebulized steroids. |
doi_str_mv | 10.1111/j.1399-3038.2008.00716.x |
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However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this study, the effects of nebulized budesonide and nebulized fluticasone propionate suspensions on hypothalamic–pituitary–adrenal axis is examined in infants with recurrent or persistent wheeze. Thirty‐one children aged 6–24 months admitted to our hospital between January and December 2005 with symptoms of recurrent or persistent wheeze were included in the study. The patients were randomly allocated to receive 0.25 mg BUD or 0.25 mg fluticasone propionate twice daily for 6 wk and half dose for another 6 wk with a jet nebulizer at home. Blood samples for basal cortisol concentration, adrenocarticotropic hormone, glucose, HbA1c and electrolytes were obtained at the beginning and at the end of the study. Adrenal function assessment was based on changes in cosyntropin‐stimulated plasma cortisol levels. The study was completed with 31 patients, 16 of whom received BUD and 15 FP. All patients except one had plasma cortisol concentrations above 500 nmol/l (18 μg/dl) or had an incremental rise in cortisol of >200 nmol/l after stimulation. Although nebulized steroids seem to be safe in infancy, we recommend that adrenal functions should be tested periodically during long‐term treatment with nebulized steroids.</description><identifier>ISSN: 0905-6157</identifier><identifier>EISSN: 1399-3038</identifier><identifier>DOI: 10.1111/j.1399-3038.2008.00716.x</identifier><identifier>PMID: 18221460</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Administration, Inhalation ; Adrenocorticotropic Hormone - blood ; Androstadienes - administration & dosage ; Androstadienes - therapeutic use ; Anti-Asthmatic Agents - administration & dosage ; Anti-Asthmatic Agents - therapeutic use ; asthma ; Asthma - drug therapy ; Asthma - physiopathology ; Biological and medical sciences ; Bronchodilator Agents - administration & dosage ; Bronchodilator Agents - therapeutic use ; budesonide ; Budesonide - administration & dosage ; Budesonide - therapeutic use ; Child, Preschool ; corticosteroids ; Female ; Fluticasone ; fluticasone propionate ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Hydrocortisone - blood ; hypothalamic-pituitary-adrenal ; Hypothalamo-Hypophyseal System - drug effects ; Hypothalamo-Hypophyseal System - physiopathology ; Infant ; Male ; Medical sciences ; Nebulizers and Vaporizers ; Pituitary-Adrenal System - drug effects ; Pituitary-Adrenal System - physiopathology ; Recurrence ; Respiratory Sounds - drug effects ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><ispartof>Pediatric allergy and immunology, 2008-12, Vol.19 (8), p.773-776</ispartof><rights>2008 The Authors. 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However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this study, the effects of nebulized budesonide and nebulized fluticasone propionate suspensions on hypothalamic–pituitary–adrenal axis is examined in infants with recurrent or persistent wheeze. Thirty‐one children aged 6–24 months admitted to our hospital between January and December 2005 with symptoms of recurrent or persistent wheeze were included in the study. The patients were randomly allocated to receive 0.25 mg BUD or 0.25 mg fluticasone propionate twice daily for 6 wk and half dose for another 6 wk with a jet nebulizer at home. Blood samples for basal cortisol concentration, adrenocarticotropic hormone, glucose, HbA1c and electrolytes were obtained at the beginning and at the end of the study. Adrenal function assessment was based on changes in cosyntropin‐stimulated plasma cortisol levels. The study was completed with 31 patients, 16 of whom received BUD and 15 FP. All patients except one had plasma cortisol concentrations above 500 nmol/l (18 μg/dl) or had an incremental rise in cortisol of >200 nmol/l after stimulation. Although nebulized steroids seem to be safe in infancy, we recommend that adrenal functions should be tested periodically during long‐term treatment with nebulized steroids.</description><subject>Administration, Inhalation</subject><subject>Adrenocorticotropic Hormone - blood</subject><subject>Androstadienes - administration & dosage</subject><subject>Androstadienes - therapeutic use</subject><subject>Anti-Asthmatic Agents - administration & dosage</subject><subject>Anti-Asthmatic Agents - therapeutic use</subject><subject>asthma</subject><subject>Asthma - drug therapy</subject><subject>Asthma - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Bronchodilator Agents - administration & dosage</subject><subject>Bronchodilator Agents - therapeutic use</subject><subject>budesonide</subject><subject>Budesonide - administration & dosage</subject><subject>Budesonide - therapeutic use</subject><subject>Child, Preschool</subject><subject>corticosteroids</subject><subject>Female</subject><subject>Fluticasone</subject><subject>fluticasone propionate</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>hypothalamic-pituitary-adrenal</subject><subject>Hypothalamo-Hypophyseal System - drug effects</subject><subject>Hypothalamo-Hypophyseal System - physiopathology</subject><subject>Infant</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nebulizers and Vaporizers</subject><subject>Pituitary-Adrenal System - drug effects</subject><subject>Pituitary-Adrenal System - physiopathology</subject><subject>Recurrence</subject><subject>Respiratory Sounds - drug effects</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. 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Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>hypothalamic-pituitary-adrenal</topic><topic>Hypothalamo-Hypophyseal System - drug effects</topic><topic>Hypothalamo-Hypophyseal System - physiopathology</topic><topic>Infant</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nebulizers and Vaporizers</topic><topic>Pituitary-Adrenal System - drug effects</topic><topic>Pituitary-Adrenal System - physiopathology</topic><topic>Recurrence</topic><topic>Respiratory Sounds - drug effects</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cetinkaya, Feyzullah</creatorcontrib><creatorcontrib>Kayiran, Petek</creatorcontrib><creatorcontrib>Memioglu, Nihal</creatorcontrib><creatorcontrib>Tarim, Omer Faruk</creatorcontrib><creatorcontrib>Eren, Nezaket</creatorcontrib><creatorcontrib>Erdem, Ela</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric allergy and immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cetinkaya, Feyzullah</au><au>Kayiran, Petek</au><au>Memioglu, Nihal</au><au>Tarim, Omer Faruk</au><au>Eren, Nezaket</au><au>Erdem, Ela</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of nebulized corticosteroids therapy on hypothalamic-pituitary-adrenal axis in young children with recurrent or persistent wheeze</atitle><jtitle>Pediatric allergy and immunology</jtitle><addtitle>Pediatr Allergy Immunol</addtitle><date>2008-12</date><risdate>2008</risdate><volume>19</volume><issue>8</issue><spage>773</spage><epage>776</epage><pages>773-776</pages><issn>0905-6157</issn><eissn>1399-3038</eissn><abstract>Inhaled corticosteroids (ICS) are preferred drugs for the long‐term treatment of all severities of asthma in children. However, data about the safety of ICS in infants is lacking. So, it is essential to do further clinical studies to examine the safety and efficacy of ICS in this population. In this study, the effects of nebulized budesonide and nebulized fluticasone propionate suspensions on hypothalamic–pituitary–adrenal axis is examined in infants with recurrent or persistent wheeze. Thirty‐one children aged 6–24 months admitted to our hospital between January and December 2005 with symptoms of recurrent or persistent wheeze were included in the study. The patients were randomly allocated to receive 0.25 mg BUD or 0.25 mg fluticasone propionate twice daily for 6 wk and half dose for another 6 wk with a jet nebulizer at home. Blood samples for basal cortisol concentration, adrenocarticotropic hormone, glucose, HbA1c and electrolytes were obtained at the beginning and at the end of the study. Adrenal function assessment was based on changes in cosyntropin‐stimulated plasma cortisol levels. The study was completed with 31 patients, 16 of whom received BUD and 15 FP. All patients except one had plasma cortisol concentrations above 500 nmol/l (18 μg/dl) or had an incremental rise in cortisol of >200 nmol/l after stimulation. Although nebulized steroids seem to be safe in infancy, we recommend that adrenal functions should be tested periodically during long‐term treatment with nebulized steroids.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18221460</pmid><doi>10.1111/j.1399-3038.2008.00716.x</doi><tpages>4</tpages></addata></record> |
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subjects | Administration, Inhalation Adrenocorticotropic Hormone - blood Androstadienes - administration & dosage Androstadienes - therapeutic use Anti-Asthmatic Agents - administration & dosage Anti-Asthmatic Agents - therapeutic use asthma Asthma - drug therapy Asthma - physiopathology Biological and medical sciences Bronchodilator Agents - administration & dosage Bronchodilator Agents - therapeutic use budesonide Budesonide - administration & dosage Budesonide - therapeutic use Child, Preschool corticosteroids Female Fluticasone fluticasone propionate Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Hydrocortisone - blood hypothalamic-pituitary-adrenal Hypothalamo-Hypophyseal System - drug effects Hypothalamo-Hypophyseal System - physiopathology Infant Male Medical sciences Nebulizers and Vaporizers Pituitary-Adrenal System - drug effects Pituitary-Adrenal System - physiopathology Recurrence Respiratory Sounds - drug effects Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis |
title | Effects of nebulized corticosteroids therapy on hypothalamic-pituitary-adrenal axis in young children with recurrent or persistent wheeze |
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