Use of the Low-Dose Corticotropin Stimulation Test for the Monitoring of Children with Asthma Treated with Inhaled Corticosteroids

2006 ◽  
Vol 66 (2) ◽  
pp. 51-60 ◽  
Author(s):  
M.C. Raux Demay ◽  
J.P. Magny ◽  
N. Idrès ◽  
A. Grimfeld ◽  
Y. Le Bouc
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Stimulation Test ◽  
Children With Asthma ◽  
Corticotropin Stimulation

The short Synacthen test: a questionnaire survey of current usage

2012 ◽  
Vol 97 (10) ◽  
pp. 870-873 ◽  
Author(s):  
Charlotte Jane Elder ◽  
Pooja Sachdev ◽  
Neil Peter Wright
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
British Society ◽  
High Dose ◽  
Paediatric Endocrinology ◽  
Children With Asthma ◽  
Synacthen Test ◽  
The Uk ◽  
Meta Analyses ◽  
Short Synacthen Test

BackgroundSupported by meta-analyses, the low-dose Synacthen test (LDST) has gained in popularity, with many believing it to be more sensitive than the supraphysiological standard (250 µg) short ST (SSST), particularly when assessing children prescribed high-dose inhaled corticosteroids (HDICS). However, consensus is lacking about its specific clinical application, what is considered ‘low dose’ and how that dose is made up.MethodsTo ascertain current use of the short Synacthen test (SST), a questionnaire was emailed to members of the British Society of Paediatric Endocrinology and Diabetes in the UK and Ireland (N=257), requesting a response from each department (N=92). A reminder was sent a month later to members of departments which had not responded.ResultsThe authors received 39 replies, giving a response rate of 42%. All departments use the SST: 82% use an LDST, 87% use the SSST and 69% use both. The 1 µg dose was used by 44% of hospitals, with the other 56% using seven different doses based on age, weight and body surface area. There were 14 different methods of preparing the low dose test. Additionally, variations in the timings of cortisol sampling and the diagnostic cut-offs for adrenal insufficiency were found. Increased requests for SSTs in children with asthma prescribed HDICS were noted by 44% of respondents, with 67% reporting the detection of adrenal suppression in this group.ConclusionStandardisation of the SST is required to address the considerable variation in the methodology and application of this test in the UK and Ireland.

scholarly journals Influence of weight status in the response to Step-2 maintenance therapies in children with asthma

2019 ◽  
Vol 6 (1) ◽  
pp. e000401 ◽  
Author(s):  
Cristina Longo ◽  
Gillian Bartlett ◽  
Tibor Schuster ◽  
Francine M. Ducharme ◽  
Brenda MacGibbon ◽  
...  
Keyword(s):  
Weight Status ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Administrative Databases ◽  
Ratio Test ◽  
Historical Cohort ◽  
Cox Models ◽  
Early Management ◽  
Unit Increase ◽  
Children With Asthma

IntroductionOverweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy.MethodsA historical cohort study from clinical data linked to administrative databases was conducted among children aged 2–18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children’s Hospital Asthma Centre. The outcome was time-to-management failure defined as any step-up in therapy, acute care visit, hospitalisation or oral corticosteroids for asthma, whichever occurred first. The independent and joint effects of weight status (body mass index [BMI] percentile) and time-varying treatment on time-to-management failure were estimated with marginal structural Cox models. The likelihood ratio test (LRT) and relative excess risk due to interaction (RERI) were computed to assess treatment effect modification by weight status on the multiplicative and additive scales.ResultsOf the 433 and 85 visits with a low-dose ICS and LTRA prescription, respectively, 388 management failures occurred over 14 529 visit-weeks of follow-up. Children using LTRA compared with low-dose ICS tended to have an overall higher risk of early management failure (HR 1.52; 95% CI 0.72 to 3.22). Irrespective of treatment, the hazard of management failure increased by 5% (HR 1.05; 95% CI 1.01 to 1.10) for every 10-unit increase in BMI percentile. An additional hazard reduction of 17% (HR 0.83; 95% CI 0.70 to 0.99) was observed for every 10-unit increase in BMI percentile among LTRA users, but not for ICS (HR 0.95; 95% CI 0.86 to 1.04). The LRT indicated a departure from exact multiplicativity (p<0.0001), and the RERIs for ICS and LTRA were −0.05 (95% CI −0.14 to 0.05) and −0.52 (95% CI −1.76 to 0.71).ConclusionsWeight status was associated with earlier time-to-management failure in children prescribed Step-2 therapy. This hypothesis-generating study suggests that LTRA response increases in children with higher BMI percentiles, although further research is warranted to confirm findings.

The low-dose corticotropin stimulation test in acute traumatic and non-traumatic brain injury: incidence of hypo-responsiveness and relationship to outcome

2004 ◽  
Vol 30 (6) ◽  
pp. 1216-1219 ◽  
Author(s):  
Ioanna Dimopoulou ◽  
Stylianos Tsagarakis ◽  
Evangelia Douka ◽  
Maria Zervou ◽  
Andreas T. Kouyialis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Low Dose ◽  
Stimulation Test ◽  
Injury Incidence ◽  
Corticotropin Stimulation

Adrenal function in non-septic long-stay critically ill patients: evaluation with the low-dose (1 µg) corticotropin stimulation test

2002 ◽  
Vol 28 (8) ◽  
pp. 1168-1171 ◽  
Author(s):  
Ioanna Dimopoulou ◽  
Ioannis Ilias ◽  
Paraskevi Roussou ◽  
Alexandra Gavala ◽  
Adigoni Malefaki ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Adrenal Function ◽  
Stimulation Test ◽  
Corticotropin Stimulation

Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 921-924
Author(s):  
Aaron L. Carrel ◽  
Stephanie Somers ◽  
Robert F. Lemanske ◽  
David B. Allen
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Chronic Asthma ◽  
Asthma Therapy ◽  
Biochemical Alterations ◽  
Clinically Significant ◽  
Dose Corticosteroid ◽  
Oral Glucocorticoids ◽  
Cortisol Deficiency

Glucocorticoids are a cornerstone of the anti-inflammatory treatment of asthma. To minimize adverse effects of oral glucocorticoids (OGC), clinicians have used alternate-day oral or inhaled corticosteroids (IC), both generally considered safe for chronic asthma therapy in children. Although reversible growth suppression occasionally occurs, the general consensus is that, despite detectable biochemical alterations, these modes of therapy are not associated with clinically significant adrenal insufficiency.1 We report the occurrence of hypoglycemia due to cortisol deficiency during combination alternate-day oral and inhaled corticosteroids. CASE HISTORY A 3½-year-old boy with asthma was found one morning to be unarousable, limp, and blue around the lips.

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