High-Dose Fluticasone Impairs Adrenal Function in Children

Doses at 1000 micrograms or more per day linked to flat response to low-dose synthetic ACTH

FRIDAY, Oct. 20 (HealthDay News) -- Children prescribed more than the maximum recommended daily dose of inhaled fluticasone proprionate are more likely to experience adrenal insufficiency, according to a report in the October issue of the Archives of Disease in Childhood.

James Paton, M.D., of the University of Glasgow in Scotland, and colleagues invited children currently prescribed 500 μg of fluticasone per day or more to undergo adrenal function testing using low-dose ACTH (Synacthen). Serum cortisol levels were used to place children in normal, impaired or flat response groups.

Of the 217 children successfully tested, 39.6 percent were found to have impaired responses to ACTH while 2.8 percent showed completely flat responses. All of the latter group received 1000 μg per day or more.

Those who require high doses or who cannot be stepped down successfully should be monitored regularly for adverse effects, notes George Russell, M.B. Ch.B., of Royal Aberdeen Children's Hospital in Scotland, in an editorial. "The best solution of all would be to avoid using very high-dose inhaled corticosteroid therapy in the first place," he adds.

Paton has received financial support from various pharmaceutical companies that produce inhaled steroids.

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