Source: Annual Congress 2007 - Novel issues in the treatment and control of asthma
Disease area: Airway diseases

Abstract

Background: Normal hypothalamic-pituitary-adrenal (HPA) axis function is a well-accepted consequence in almost all adult asthmatic patients with inhaled corticosteroids (ICS) by a conventional dose (250 mcg) adrenocorticotropin (ACTH) test. Several investigators reported to find a latent suppression of HPA function in child asthmatic patients with ICS using a low-dose rapid ACTH test.
Aim: To determine the prevalence of latent HPA insufficiency in adult patients with asthma treated with ICS who have not been administered systemic or rescue glucocorticoid (GC) for at least one year, by a low-dose ACTH test.
Methods: Fifty-six asthma patients (M/F:16/40) were satisfied above criteria from Miyatake Asthma Clinic, who were started to be injected 1.0mcg ACTH from am 9.00 to 9.30 via venous rote. Three samples (0, 30 and 60 min.) were examined for serum cortisol (F) level. The criteria for normal response to the low-dose ACTH are defined as both a peak F level of more than 500nmol/L (18.1 mcg/dL) and the basal F level of more than 303nmol/L (11.0 mcg/dL).
Results: Thirty-seven patients satisfied the above criteria, while 19 patients did not. Between normal response group and hypo-response group, there was no statistical significance for clinical backgrounds, such as age, sex, duration of asthma, daily dose of ICS, cumulative dose of ICS for one year and a type of ICS.
Conclusion: A low-dose ACTH test revealed that about one-third asthma patients treated with ICS were in latent HPA insufficient state. Therefore, it appears that a low-dose ACTH test is able to show latent adrenal insufficiency, which is not detected by the conventional dose ACTH test.

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K. Fujita, S. Kasayama, M. Otsuki, M. Tanemura, A. Miyatake (Shiga, Osaka, Kyoto, Japan). A low-dose (1.0 mcg) rapid ACTH test and adrenal function in adult patients with bronchial asthma treated with inhaled corticosteroids. Eur Respir J 2007; 30: Suppl. 51, 560

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