GROWTH AND ADRENAL SUPPRESSION IN ASTHMATIC-CHILDREN TREATED WITH HIGH-DOSE FLUTICASONE PROPIONATE

Background Fluticasone propionate was introduced in 1993 in the UK as a potentially safer inhaled corticosteroid than those already in use. The efficacy and safely of fluticasone has been established at recomme nded doses of 200 mu g/day, but not at the higher doses that are often used. Methods Growth retardation was observed in six severely asthmat ic children after introduction of high-dose fluticasone propionate tre atment (dry powder). Assessment of cortisol response was by insulin-in duced hypoglycaemia in three cases, by short tetracosactrin test in tw o, and by low-dose tetracosactrin and 24-hour urinary cortisol/creatin ine ratio in one. Findings Six children with growth retardation noted after treatment with high-dose fluticasone propionate were found to ha ve adrenal suppression. In one case the growth rate and cortisol respo nse returned to normal 9 months after the fluticasone dose was reduced to 500 mu g/day. Interpretation When high doses of fluticasone propio nate are used, growth may be retarded and adrenal suppression may occu r.