Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma: Fig. 1.—

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Abstract
This cross-sectional study was designed to examine the prevalence of adrenocortical suppression in children with asthma treated with high-dose inhaled fluticasone propionate (FP).Children and adolescents (n=50) with asthma, treated with inhaled FP at a dose of ≥1,000 mg a day for ≥6 months, were enrolled. Early morning serum cortisol was performed. Subjects with a serum cortisol of −1had a tetracosactrin stimulation test.Fifty subjects of mean age 13.1 yrs were treated with a mean dose of 924.7 µg·m−2·day−1FP for a mean duration of 2 yrs. Of the 50 subjects, 36 (72%) had serum cortisol levels of −1and underwent tetracosactrin stimulation test. Of these, 6 (17%) demonstrated a less than two-fold increase in serum cortisol from baseline and peak cortisol level of ≤550 nmol·L−1at 30 or 60 min poststimulation. There was a significant negative correlation between the dose of FP·m−2and stimulated peak cortisol level.Biochemical evidence of adrenocortical insufficiency was demonstrated in 12% of the subjects, indicating that high-dose fluticasone propionate use may be associated with dose-dependent adrenocortical suppression.