The Prevalence of Hypothalamic-Pituitary-Adrenal Axis Suppression in Children with Persistent Asthma

Background: Hypothalamic-pituitary-adrenal (HPA) axis suppression is the most important systemic side effect associated with inhaled corticosteroids (ICS) therapy. Objectives: To evaluate the prevalence and determinants of hypothalamic-pituitary-adrenal (HPA) axis suppression in asthmatic children on ICSs. Methods: A total of 92 children aged 6 to 18 years, diagnosed with persistent asthma, and receiving regular ICS therapy for a minimum of 3 months, without any systemic steroid therapy within the last 3 months, were enrolled in the study. Clinical and demographic variables were recorded. HPA axis suppression was measured by morning cortisol levels and confirmed by low-dose adrenocorticotropic hormone stimulation test. Results: Of 92 enrolled patients, 51 (55.4%) were male. The mean age was 10.1 2.6 years. HPA axis suppression was observed in two (2.1%) patients. The body mass index (BMI) values were significantly lower in the HPA axis suppression group compared to the other enrollees. No relationship was observed between the HPA axis suppression and the ICS dose, duration of therapy or coadministration of long-acting beta-agonists or nasal steroids. Conclusions: In our study, the prevalence of HPA axis suppression was 2.1%. Children with persistent asthma who has been treated with regular ICS should be screened for HPA axis suppression.