SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

8/18/04

Does monitoring growth rate effect predict risk for adrenal suppression due to inhaled steroid therapy?

Summary
Background - Reduction of growth velocity and inhibition of the hypothalamic-pituitary-adrenal (HPA) axis are potential adverse effects of treatment with high dosage inhaled corticosteroids (ICS) in childhood asthma. Does the assessment of effects of ICS therapy on growth predict whether HPA suppression will occur?

Findings - Dunlop et al of the Royal Belfast Hospital for Sick Children in Ireland observed effects of high-dosage ICS treatment (budesonide 1000 mcg/day) over 6 and 12 month periods in 35 asthmatic children (ages 4-10 years). They found that a significant reduction in growth velocity was almost always accompanied by decreased HPA (specificity = 95%) but growth inhibition was not a sensitive predictor of HPA suppression (sensitivity = 13%).

Conclusions - Both growth rates and the HPA should be monitored in children receiving high dose ICS therapy. The optimal frequency for assessing HPA in such patients remains to be determined.

Reference
Arch Dis Child 2004;89:7713-16

Editor's Comments
It would certainly be desirable if the relatively simple assessment of growth rates with sensitive measuring devices (e.g., stadiometry) would reliably predict other adverse systemic effects of ICS therapy. Unfortunately, that appears not to be the case for effects on the HPA axis.

 

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