The beneficial effects of long-term treatment with inhaled corticosteroids (ICS) in childhood asthma have been documented beyond any doubt.

However, potentially important side-effects of these drugs, including adrenal suppression and growth deceleration, continue to be of concern to physicians that treat asthmatic children.

Kostas N. Priftis (Department of Allergology-Pulmonology, Penteli Children's Hospital, P. Penteli, Greece) and colleagues from Cyprus and Greece evaluated whether impairment of growth of these children can predict adrenal function suppression.

Low dose synacthen test was performed in 72 asthmatic children on long-term treatment (6-84 months) with low to moderate doses of inhaled budesonide. Changes in height standard deviation scores (HSDS) at the time of testing and height velocity SDS (HVSDS) in the preceding year were also calculated.

Adrenal suppression was demonstrated in 15 asthmatic children (20.8%) but this was only a biochemical finding, since none of these children presented symptoms of adrenal insufficiency. There were no differences in HSDS and HVSDS between children with and without adrenal suppression.

There was no correlation between adrenal response and dose or duration of treatment. However, a positive relation between HVSDS and duration of treatment was noted.

The study team concludes that long-term treatment of asthmatic children with low to moderate doses of inhaled budesonide may result in mild adrenal suppression that can not be predicted by growth deceleration. An idiosyncratic sensitivity of some children to ICSs may exist.

As the duration of treatment with ICS is prolonged, the negative influence of these drugs on children's growth diminishes.

Title of the original article:
The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

EUROPEAN RESPIRATORY JOURNAL