1 - Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, E.P.E., Rua Jacinta Marto, Lisbon, Portugal
2 - NOVA Medical School - Comprehensive Health Research Center (CHRC), Lisbon, Portugal
- EAACI Congress 2020, reunião internacional, apresentação sob a forma de poster
Resumo:
Background: The use of salivary cortisol to measure the hypothalamic-pituitary adrenal axis (HPA) function has become a popular non-invasive method to assess free serum cortisol. Literature reports adrenal secondary insufficiency related with inhaled- corticosteroids (ICS), however data about the magnitude of this effect in patients with severe asthma and subsequent treatment of high doses of ICS is lacking. salivary cortisol to evaluate hypothalamic-pituitary adrenal axis (HPA) function.
Patients Method: We analyzed retrospectively data from a cohort of patients with severe asthma who measured collected one sample of saliva using a swab, which was placed in the mouth and chewed for one minute, in the first 30 minutes after awakening and after suspension of 12 hours of ICS. After that, they were frozen and stored until the enzyme immunoassay in our Hospital’s laboratory. The samples were obtained along 4 years (2016-2019). Patients in maintenance treatment with oral corticosteroids were excluded from the analysis.
Results: We included 28 patients, 19 were females (68%), 17 were children and the median age was 15 years old (P25-P75: 13-46). Within the inhaled glucocorticoids 11 patients used Fluticasone Fuorate - dry powder inhaler (DPI) (200 mcg/daily dose), while 10 were under Fluticasone propionate (DPI)(500 - 1000mcg/daily) and seven used Budesonide (DPI) (800 mcg/daily). We were able to identify 7 patients (25%) with lower values of salivary cortisol after awakening. Children (4 patients; 24%) had similar rates of low values of salivary cortisol compared to adults (3 patients; 27%). Patients treated under Fluticasone Fuorate had higher rates of low salivary cortisol (45%;) compared to other ICS (12%; p=0.05).
Conclusion: These results suggest that patients with severe asthma may often have high levels of HPA suppression even without maintenance treatment with oral corticosteroids. Severe asthma patients should be screened for HPA suppression to avoid its consequences, especially adrenal crisis as the most severe.