Assessment of hair cortisol as a potential biomarker for possible adrenal suppression due to inhaled corticosteroid use in children with asthma: A retrospective observational study

• Published in: Clinical biochemistry 2018-06, Vol.56, p.26-32
• Main Authors: Smy, Laura, Shaw, Kaitlyn, Amstutz, Ursula, Staub, Michelle, Chaudhry, Shahnaz, Smith, Anne, Carleton, Bruce, Koren, Gideon
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adrenal Glands - drug effects; Adrenal Glands - metabolism; Adrenal Insufficiency - chemically induced; Adrenal Insufficiency - epidemiology; Adrenal Insufficiency - metabolism; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - metabolism; Biomarker; Biomarkers - metabolism; Canada - epidemiology; Child; Child, Preschool; Children; Cohort Studies; Female; Hair - metabolism; Hair cortisol; Humans; Hydrocortisone - metabolism; Immunoenzyme Techniques; Inhaled corticosteroids; Male; Outpatient Clinics, Hospital; Pilot Projects; Regression Analysis; Retrospective Studies; Risk
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2018.04.006

Inhaled corticosteroids (ICS) are the recommended long-term control therapy for asthma in children. However, concern exists regarding potential adrenal suppression with chronic ICS use. Our pilot study reported that hair cortisol in children was 50% lower during ICS therapy than prior to therapy, suggestive of adrenal suppression. To evaluate hair cortisol concentration (HCC) as a potential biomarker for possible adrenal suppression from ICS use in children with asthma. A retrospective observational study was performed at asthma clinics in Vancouver, Winnipeg, and Toronto, Canada. Children (n = 586) were recruited from July 2012 to December 2014 inclusive of those without asthma, with asthma not using ICS, and with asthma using ICS. The most recent three-month HCC was measured by enzyme immunoassay and compared among the groups. Quantile regression analysis was performed to identify factors potentially affecting HCC. The median HCC was not significantly different among the children: No ICS (n = 47, 6.7 ng/g, interquartile range (IQR) 3.7–9.8 ng/g), ICS Treated (n = 360, 6.5 ng/g, IQR 3.8–14.3 ng/g), and Controls (n = 53, 5.8 ng/g, IQR 4.6–16.7 ng/g). 5.6% of the children using ICS had hair cortisol