Endocrine effects of inhaled corticosteroids in children

Chirag R. Kapadia, Todd Nebesio, Susan E. Myers, Steven Willi, Bradley S. Miller, David B. Allen, Elka Jacobson-Dickman

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Inhaled corticosteroids (ICSs) are widely used as first-line treatment for various chronic respiratory illnesses. Advances in devices and formulations have reduced their local adverse effects. However, as delivery of ICSs to the lungs improves, the systemic absorption increases, and an adverse effect profile similar to, although milder than, oral corticosteroids has emerged. The most serious potential adverse effect is adrenal insufficiency, which can be life threatening. Adrenal insufficiency occurs most in patients taking the highest doses of ICSs but is reported with moderate or even low doses as well. Our recommendations include greater vigilance in testing adrenal function than current standard practice. In patients with diabetes mellitus (types 1 and 2), an increase in glucose levels is likely, and diabetes medication adjustment may be needed when initiating or increasing ICSs. The risk of linear growth attenuation and adverse effects on bone mineral density is generally low but should be considered in the face of additional risk factors. On behalf of the Pediatric Endocrine Society Drugs and Therapeutics Committee, we present a review of the endocrine adverse effects of ICSs in children and offer recommendations relating to testing and referral. Limited data in particular realms diminish the strength of certain recommendations, and clinical judgment continues to be paramount.

Original languageEnglish (US)
Pages (from-to)163-170
Number of pages8
JournalJAMA Pediatrics
Volume170
Issue number2
DOIs
StatePublished - Feb 1 2016

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Adrenal Cortex Hormones
Pharmacy and Therapeutics Committee
Adrenal Insufficiency
Social Adjustment
Type 1 Diabetes Mellitus
Bone Density
Type 2 Diabetes Mellitus
Chronic Disease
Referral and Consultation
Pediatrics
Glucose
Equipment and Supplies
Lung
Growth
Therapeutics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kapadia, C. R., Nebesio, T., Myers, S. E., Willi, S., Miller, B. S., Allen, D. B., & Jacobson-Dickman, E. (2016). Endocrine effects of inhaled corticosteroids in children. JAMA Pediatrics, 170(2), 163-170. https://doi.org/10.1001/jamapediatrics.2015.3526

Endocrine effects of inhaled corticosteroids in children. / Kapadia, Chirag R.; Nebesio, Todd; Myers, Susan E.; Willi, Steven; Miller, Bradley S.; Allen, David B.; Jacobson-Dickman, Elka.

In: JAMA Pediatrics, Vol. 170, No. 2, 01.02.2016, p. 163-170.

Research output: Contribution to journalArticle

Kapadia, CR, Nebesio, T, Myers, SE, Willi, S, Miller, BS, Allen, DB & Jacobson-Dickman, E 2016, 'Endocrine effects of inhaled corticosteroids in children', JAMA Pediatrics, vol. 170, no. 2, pp. 163-170. https://doi.org/10.1001/jamapediatrics.2015.3526
Kapadia CR, Nebesio T, Myers SE, Willi S, Miller BS, Allen DB et al. Endocrine effects of inhaled corticosteroids in children. JAMA Pediatrics. 2016 Feb 1;170(2):163-170. https://doi.org/10.1001/jamapediatrics.2015.3526
Kapadia, Chirag R. ; Nebesio, Todd ; Myers, Susan E. ; Willi, Steven ; Miller, Bradley S. ; Allen, David B. ; Jacobson-Dickman, Elka. / Endocrine effects of inhaled corticosteroids in children. In: JAMA Pediatrics. 2016 ; Vol. 170, No. 2. pp. 163-170.
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