Background: Inhaled corticosteroids (ICS) and intranasal steroids (INS) are frequently co-administered in children with asthma and rhinitis. In contrast to monotherapy with ICS or INS, little is known about the safety of concurrent use of topical steroids on HPA axis function in prepubertal children.
Objective: Comparison of morning salivary cortisol levels in prepubertal children using maintenance treatment with ICS with and without concurrent use of INS to a steroid naïve control group.
Methods: Cross-sectional observational study in prepubertal children (6-12 years) using ICS alone (n=41) or in combination with INS (n=22), compared to a control group with no steroid treatment (n=28). Morning salivary cortisol levels were determined from saliva samples collected at home.
Results: The morning salivary cortisol levels of prepubertal children using ICS (median 5.1 nmol/l; 95% CI 4.1 to 7.6) or a combination of ICS and INS (4.8 nmol/l; 4.6 to 8.1) were comparable, but significantly reduced compared to the steroid naïve control group (8.9 nmol/l; 8.0 to 11.3). There was no correlation between salivary cortisol level and cumulative daily dose of topical steroids.
Conclusion: Salivary cortisol levels in prepubertal children using ICS, with or without concurrent use of INS, were comparable. However, salivary cortisol levels were significantly reduced compared to steroid naïve controls, irrespective of the cumulative daily dose of topical steroids.
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Heijsman, S., Kamps, A., Wolthuis, A. et al. 256 Poster Presentation Abstracts Salivary Cortisol Levels in Prepubertal Children Using Inhaled Corticosteroids with or without Concurrent Intranasal Corticosteroids. Pediatr Res 68, 133 (2010). https://doi.org/10.1203/00006450-201011001-00256