ADRENAL SUPPRESSION AMONG ASTHMATIC-CHILDREN RECEIVING CHRONIC THERAPY WITH INHALED CORTICOSTEROID WITH AND WITHOUT SPACER DEVICE

Background: Inhaled corticosteriods have become a first-line treatment for chronic asthma. It has been shown that inhaled corticosteroids ca n have a measurable effect on the hypothalamic-pituitary-adrenal axis in asthmatic children, Objective: To investigate the prevalence of adr enal suppression among asthmatic children receiving chronic therapy wi th low to moderate doses (up to 1000 mu g) of inhaled beclomethasone d ipropionate via a metered dose inhaler (MDI) and via MDI attached to a spacer device (MDI-spacer). Methods: The study included 39 asthmatic children currently undergoing therapy; 24 received beclomethasone dipr opionate by MDI attached to a spacer, and 15 directly by MDI. All the patients had been treated for at least 4 months. Another 21 children w ere normal controls. The 24-hour urinary free cortisol excretion was m easured to evaluate hypothalamic-pituitary-adrenal axis function. Resu lts: Seven of 15 (47%) patients from the MDI group had reduced 24 hour -urinary free cortisol excretion and 2 of 24 (8%) in the MDI-spacer gr oup (P = .006). The mean 24-hour urinary free cortisol excretion of th e MDI group was 0.0185 +/- 0.0089 mu g/g creatinine, and the MDI-space r and the control groups were, 0.0290 +/- 0.0138 mu g/g creatinine and 0.0270 +/- 0.0118 mu g/g creatinine, respectively, (P = .037, f = 3.5 1 ANOVA). Conclusion: Chronic inhalation of low to moderate doses of c orticosteroids is associated with adrenal suppression in some asthmati c children. This side effect is more common among patients inhaling di rectly from the MDI and is less frequent when a large volume spacer is attached to the MDI.