Adrenal suppression, evaluated by a low dose adrenocorticotropin test, andgrowth in asthmatic children treated with inhaled steroids

The aim of the present study was to evaluate the prevalence of adrenal supp ression and growth retardation in children using moderate doses of budesoni de or fluticasone propionate. Seventy-five asthmatic children were randomly divided into three treatment groups: 30 to the fluticasone propionate (FP) , 30 to the budesonide (BUD), and 15 to the cromone (CROM) group. FP doses were 500 mu g/day during the first 2 months and 200 mu g/day thereafter. Th e respective BUD doses were 800 and 400 mu g/day. A low dose ACTH (0.5 mu g /1.73 m(2)) test was performed before treatment and 2, 4, and 6 months late r. The test was considered abnormal if the stimulated serum cortisol concen tration was more than 2 so lower than the pretreatment mean (<330 nmol/L). The low dose ACTH test was abnormal after both the high and low steroid dos es in 23% of the children. At the 4 month measurement there were more abnor mal tests in the BUD (n = 9) than in the FP (n = 5) group (P < 0.05). At th at time also the stimulated concentration of serum cortisol was lower in th e BUD than in the CROM group (P < 0.01), whereas the difference between the FP and CROM groups was not significant. During the study year the mean dec rease in height so score was 0.23 in the children treated with BUD, 0.03 in the children treated with FP, and 0.09 in the children treated with CROM; the difference between the BUD and FP groups was significant (P < 0.05). In conclusion, the low dose ACTH test revealed mild adrenal suppression in a quarter of the children using moderate doses of inhaled steroids. A FP do se of 200 mu g/day caused less adrenal and growth suppression than did a BU D dose of 400 pg/day.