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Adrenal suppression in asthmatic children receiving low-dose inhaled budesonide: comparison between dry powder inhaler and pressurized metered-dose inhaler attached to a spacer.

https://arctichealth.org/en/permalink/ahliterature15304
Source
Ann Allergy Asthma Immunol. 2002 Dec;89(6):566-71
Publication Type
Article
Date
Dec-2002
Author
Shmuel Goldberg
Tsurit Einot
Nurit Algur
Shimshon Schwartz
Alan C Greenberg
Elie Picard
Dov Virgilis
Eitan Kerem
Author Affiliation
Department of Pediatric Respiratory Medicine, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel.
Source
Ann Allergy Asthma Immunol. 2002 Dec;89(6):566-71
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Absorption
Administration, Inhalation
Adolescent
Adrenal Cortex - secretion
Aerosols
Anti-Asthmatic Agents - administration & dosage - adverse effects - pharmacology
Biological Availability
Budesonide - administration & dosage - adverse effects - pharmacology
Child
Child, Preschool
Comparative Study
Cross-Over Studies
Depression, Chemical
Female
Humans
Hydrocortisone - secretion - urine
Hypothalamo-Hypophyseal System - drug effects
Inhalation Spacers
Lung - metabolism
Male
Pituitary-Adrenal System - drug effects
Powders
Abstract
BACKGROUND: Dry powder inhalers (DPI) have in recent years become a common mode for administration of inhaled corticosteroids for preventive therapy of asthma. Inhaled steroids delivered by DPI achieve increased lung deposition compared with pressurized metered-dose inhalers (pMDI), which is associated with increased therapeutic effect. This may be associated with increased systemic absorption. OBJECTIVE: The purpose of this study was to evaluate the prevalence of adrenal suppression in children using low-dose budesonide given by DPI, as compared with pMDI attached to a large-volume spacer device (pMDI + spacer). METHODS: In an open-labeled crossover study, 15 asthmatic children aged 5 to 15 years received 200 microg of inhaled budesonide twice daily by DPI (Turbuhaler, Astra, Draco AB, Lund, Sweden) and by pMDI + spacer, 1 month each, in a randomized order. Twenty-four-hour urine collections were performed at baseline and at the end of each of the 2 months of the study period, and urinary cortisol and creatinine were measured. RESULTS: Baseline urinary cortisol:creatinine was 0.038 +/- 0.012 microg/mg, similar in both groups. After 1 month of DPI therapy, urinary cortisol:creatinine was reduced by 27 +/- 16% to 0.028 +/- 0.012 microg/mg (P = 0.018). Urinary cortisol:creatinine after 1 month of pMDI + spacer therapy was similar to baseline 0.037 +/- 0.019 microg/mg (P = 0.78). CONCLUSIONS: Treatment of asthmatic children with budesonide 400 microg daily given via a DPI for 1 month was associated with hypothalamic-pituitary-adrenal axis suppression. This effect was not observed with the same dose of budesonide administered via pMDI + spacer. This indicates that systemic absorption might be reduced with pMDI + spacer therapy.
Notes
Comment In: Ann Allergy Asthma Immunol. 2002 Dec;89(6):537-912487216
Comment In: Ann Allergy Asthma Immunol. 2003 Jun;90(6):674; author reply 674-512839330
PubMed ID
12487221 View in PubMed
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