Abstract
Bloodspot cortisol, where finger pricked blood is applied to blotting paper, is suitable for repeated measurements in the home environment. The use of bloodspot cortisol measurements in children with asthma and the effect of inhaled corticosteroids on daytime cortisol concentrations were assessed. Twenty children with mild asthma were randomised to receive double blind either placebo or beclomethasone dipropionate 200 micrograms twice daily. Blood was taken by finger prick at home on waking, and treatment administered. Blood was then taken one hour after treatment, at lunchtime, and in the evening. The area under the curve (AUC) for the four time points was calculated as a composite index of daytime cortisol. Mean (SEM) bloodspot cortisols fell progressively over the day from 199.2 (15.6) nmol/l to 58.4 (8.9) nmol/l. Cortisol in the group treated with beclomethasone dipropionate was lower at all time points, but was significant only after treatment (mean (SEM) 120.9 (14.3) v 177.5 (21.0) nmol/l) and at lunchtime (mean (SEM) 82.7 (12.4) v 128.9 (12.6) nmol/l). AUC for the beclomethasone dipropionate treated group was also significantly decreased (mean (SEM) 317 (31.4) v 446 (29.7)). Beclomethasone dipropionate at a dose of 400 micrograms/day significantly suppresses the daytime cortisol profile.
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Selected References
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- Ali N. J., Capewell S., Ward M. J. Bone turnover during high dose inhaled corticosteroid treatment. Thorax. 1991 Mar;46(3):160–164. doi: 10.1136/thx.46.3.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baran D. A comparison of inhaled budesonide and beclomethasone dipropionate in childhood asthma. Br J Dis Chest. 1987 Apr;81(2):170–175. doi: 10.1016/0007-0971(87)90135-5. [DOI] [PubMed] [Google Scholar]
- Bhan G. L., Gwynn C. M., Smith J. M. Growth and adrenal function of children on prolonged beclomethasone dipropionate treatment. Lancet. 1980 Jan 12;1(8159):96–97. doi: 10.1016/s0140-6736(80)90522-x. [DOI] [PubMed] [Google Scholar]
- Bisgaard H., Damkjaer Nielsen M., Andersen B., Andersen P., Foged N., Fuglsang G., Høst A., Leth C., Pedersen M., Pelck I. Adrenal function in children with bronchial asthma treated with beclomethasone dipropionate or budesonide. J Allergy Clin Immunol. 1988 Jun;81(6):1088–1095. doi: 10.1016/0091-6749(88)90874-3. [DOI] [PubMed] [Google Scholar]
- Capewell S., Reynolds S., Shuttleworth D., Edwards C., Finlay A. Y. Purpura and dermal thinning associated with high dose inhaled corticosteroids. BMJ. 1990 Jun 16;300(6739):1548–1551. doi: 10.1136/bmj.300.6739.1548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Field H. V., Jenkinson P. M., Frame M. H., Warner J. O. Asthma treatment with a new corticosteroid aerosol, budesonide, administered twice daily by spacer inhaler. Arch Dis Child. 1982 Nov;57(11):864–866. doi: 10.1136/adc.57.11.864. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goldstein D. E., König P. Effect of inhaled beclomethasone dipropionate on hypothalamic-pituitary-adrenal axis function in children with asthma. Pediatrics. 1983 Jul;72(1):60–64. [PubMed] [Google Scholar]
- Henriksen J. M., Dahl R. Effects of inhaled budesonide alone and in combination with low-dose terbutaline in children with exercise-induced asthma. Am Rev Respir Dis. 1983 Dec;128(6):993–997. doi: 10.1164/arrd.1983.128.6.993. [DOI] [PubMed] [Google Scholar]
- Holt P. R., Lowndes D. W., Smithies E., Dixon G. T. The effect of an inhaled steroid on the hypothalamic-pituitary-adrenal axis--which tests should be used? Clin Exp Allergy. 1990 Mar;20(2):145–149. doi: 10.1111/j.1365-2222.1990.tb02659.x. [DOI] [PubMed] [Google Scholar]
- Kerrebijn K. F. Beclomethasone dipropionate in long-term treatment of asthma in children. J Pediatr. 1976 Nov;89(5):821–826. doi: 10.1016/s0022-3476(76)80816-5. [DOI] [PubMed] [Google Scholar]
- Law C. M., Marchant J. L., Honour J. W., Preece M. A., Warner J. O. Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet. 1986 Apr 26;1(8487):942–944. doi: 10.1016/s0140-6736(86)91045-7. [DOI] [PubMed] [Google Scholar]
- Littlewood J. M., Johnson A. W., Edwards P. A., Littlewood A. E. Growth retardation in asthmatic children treated with inhaled beclomethasone dipropionate. Lancet. 1988 Jan 16;1(8577):115–116. doi: 10.1016/s0140-6736(88)90310-8. [DOI] [PubMed] [Google Scholar]
- Nicolaizik W. H., Marchant J. L., Preece M. A., Warner J. O. Endocrine and lung function in asthmatic children on inhaled corticosteroids. Am J Respir Crit Care Med. 1994 Sep;150(3):624–628. doi: 10.1164/ajrccm.150.3.8087329. [DOI] [PubMed] [Google Scholar]
- Pedersen S., Fuglsang G. Urine cortisol excretion in children treated with high doses of inhaled corticosteroids: a comparison of budesonide and beclomethasone. Eur Respir J. 1988 May;1(5):433–435. [PubMed] [Google Scholar]
- Pijls N. H., Driessen M. N. Suppression of pituitary-adrenal axis in children on beclomethasone dipropionate inhalation therapy. Lancet. 1984 Jul 21;2(8395):173–174. doi: 10.1016/s0140-6736(84)91096-1. [DOI] [PubMed] [Google Scholar]
- Priftis K., Milner A. D., Conway E., Honour J. W. Adrenal function in asthma. Arch Dis Child. 1990 Aug;65(8):838–840. doi: 10.1136/adc.65.8.838. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Springer C., Avital A., Maayan C., Rosler A., Godfrey S. Comparison of budesonide and beclomethasone dipropionate for treatment of asthma. Arch Dis Child. 1987 Aug;62(8):815–819. doi: 10.1136/adc.62.8.815. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Varsano I., Volovitz B., Malik H., Amir Y. Safety of 1 year of treatment with budesonide in young children with asthma. J Allergy Clin Immunol. 1990 May;85(5):914–920. doi: 10.1016/0091-6749(90)90077-h. [DOI] [PubMed] [Google Scholar]
- Volovitz B., Amir J., Malik H., Kauschansky A., Varsano I. Growth and pituitary-adrenal function in children with severe asthma treated with inhaled budesonide. N Engl J Med. 1993 Dec 2;329(23):1703–1708. doi: 10.1056/NEJM199312023292305. [DOI] [PubMed] [Google Scholar]
- Williams H., Read G. F., Verrier-Jones E. R., Hughes I. A. Effect of inhaled beclomethasone dipropionate on saliva cortisol concentrations. Arch Dis Child. 1984 Jun;59(6):553–556. doi: 10.1136/adc.59.6.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wong J., Black P. Acute adrenal insufficiency associated with high dose inhaled steroids. BMJ. 1992 May 30;304(6839):1415–1415. doi: 10.1136/bmj.304.6839.1415-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zadik Z., De Lacerda L., De Carmargo L. A., Hamilton B. P., Migeon C. J., Kowarski A. A. A comparative study of urinary 17-hydroxycorticosteroids, urinary free cortisol, and the integrated concentration of plasma cortisol. J Clin Endocrinol Metab. 1980 Nov;51(5):1099–1101. doi: 10.1210/jcem-51-5-1099. [DOI] [PubMed] [Google Scholar]
- Zwaan C. M., Odink R. J., Delemarre-van de Waal H. A., Dankert-Roelse J. E., Bokma J. A. Acute adrenal insufficiency after discontinuation of inhaled corticosteroid therapy. Lancet. 1992 Nov 21;340(8830):1289–1290. doi: 10.1016/0140-6736(92)92991-n. [DOI] [PubMed] [Google Scholar]