Adrenal function in asthma

Article Abstract:

The use of steroids administered by inhalation for the treatment of childhood asthma has been associated with systemic side effects. There is evidence that high doses suppress hypothalamic-pituitary-adrenal system function, while normal function can be maintained with low doses of inhaled steroids. There have been concerns that adverse effects on growth could be the result of the use of inhaled steroids or of the asthma itself. Forty-eight children with asthma treated with the corticosteroid beclomethasone dipropionate administered by inhalation were studied to investigate adrenal function in asthmatics. Measurements of 24-hour total cortisol metabolite excretion and the excreted androgen metabolites in the urine were made. Measurement of total cortisol metabolite excretion has been recommended as an alternative to the 24-hour urinary free cortisol output as an indicator of adrenocortical activity. Cortisol production was reduced in some but not all of the children studied. There was no reduction in children who did not take inhaled steroids. Twenty-five children had a dose-dependent suppression of daily cortisol excretion. Below-average levels of androgen (a male hormone) were apparent and this may be the cause of growth delay seen in asthmatic children. There was no correlation between the cortisol metabolite or total cortisol metabolite excretion and the length of beclomethasone therapy. Suppression of adrenal function occurred in patients receiving high doses of inhaled steroids. The side effect is not reason to discourage use of beclomethasone for the treatment of childhood asthma. Endocrine assessment is necessary and recommended for all children receiving doses of beclomethasone higher than 400 micrograms per square meter of body area per day. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Steroids (Drugs), Steroids (Organic compounds), Beclomethasone dipropionate, Pituitary-adrenal function tests, Beclomethasone

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Nebulised water as a bronchoconstricting challenge in infancy

Article Abstract:

Bronchial hyperreactivity (the tendency of bronchial tubes to constrict when exposed to histamine, cold air, or other stimuli) often develops after infants have lower respiratory tract illnesses such as pneumonia. The effects of antiasthmatic drugs in infants with reactive airway disease can aid the understanding of the mechanism of the disease and in the evaluation of new treatments. In studies of these drugs, bronchoconstriction has been provoked in asthmatic adults and older children with fine mists of water. To determine whether drugs are effective in decreasing bronchoconstriction after such challenges, it is important to determine whether a refractory period occurs, in which the airway is unresponsive to further stimulation. The airway responses to nebulized water of 100 infants with a history of wheezing were studied. Measurable responses were obtained in 88 of 100 infants, and 51 of the 88 infants had more than a 20 percent increase in airway resistance, indicating bronchoconstriction occurred. The effects of a second, challenge, application of nebulized water were studied in 20 of the 51 infants with bronchoconstriction. After the challenge, all but five had at least a 20 percent increase in airway resistance, indicating that no refractory period in bronchial hyperreactivity occurs in at least 75 percent of infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Bronchitis in children

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Nebulised sodium cromoglycate in infancy: airway protection after deterioration

Article Abstract:

Constriction of the airways is the normal response to inhalation of nebulized water (water in mist form). In the assessment of asthma in infants, the airways are tested, or challenged, with nebulized water to evaluate the reactivity of the bronchi. In addition, the protective effect of various drugs used to treat asthma can be determined this way, by giving the drug before the challenge with nebulized water to see if the drug protects against bronchoconstriction (constriction of the bronchi). During an 18-month period, 100 wheezy infants were challenged with nebulized water, and 53 of these infants experienced bronchoconstriction. Thirteen of 53 infants were then given nebulized sodium cromoglycate, a medicine that is useful in treating asthma-associated airway obstruction, and then they were rechallenged with nebulized water. As determined by specific conductance, lung function decreased after both the water and the sodium cromoglycate challenge. However, no difference in lung function was observed after rechallenge with nebulized water, after the sodium cromoglycate was given. This study suggests that although nebulized sodium cromoglycate initially decreased lung function, it later provided protection against bronchoconstriction induced by nebulized water. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Cromolyn sodium

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