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the treatment and placebo groups required the addition REVIEWER COMMENTS. Systemic are both his- of fluticasone equally, which suggests that perhaps those torically and currently the mainstay treatment for acute in the treatment group had worse disease. Prestudy lung , given their ability to reduce hospitalizations, function was not tested, and individual atopic status was decrease relapses, regain asthma control, and improve not assessed to determine if these 2 groups were truly lung function. However, the risks associated with the equivalent. Studies are needed to determine if atopy is a frequent use of oral corticosteroids have led researchers confounding factor and whether controlling for to search for an alternative treatment for acute asthma. exposure in addition to ICS has an effect on asthma Although previous studies have shown oral corticoste- outcomes. This study and other similar studies suggest roids to be superior to inhaled in severe acute that ICS can improve asthma symptoms, but early use asthma, the question remains as to whether inhaled does not modify the disease. corticosteroids could be used in mild and moderate URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846QQQ asthma exacerbations. This study addressed this question Patricia Gomez Dinger, DO and determined that oral corticosteroids are superior to Michael S. Kaplan, MD inhaled steroids, even for mild exacerbations of asthma, Los Angeles, CA in regard to relapse rate and time to FEV1 improvement. These findings support the current use of oral steroids for High-Dose Inhaled Does Not treatment of mild-to-moderate acute asthma. Replace Oral Prednisolone in Children With Mild to Moderate Acute Asthma URL: www.pediatrics.org/cgi/doi/10.1542/peds.2007-0846RRR Schuh S, Dick PT, Stephens D, et al. Pediatrics. 2006; Christine Virnig, MD 118:644–650 Mark H. Moss, MD Madison, WI PURPOSE OF THE STUDY. To evaluate whether there is a signif- icant difference in the degree of impairment in forced Assessment of Adrenal Suppression in expiratory volume at 1 second (FEV ) in children with 1 Children With Asthma Treated With mild-to-moderate acute asthma treated with either in- Inhaled Corticosteroids: Use of haled fluticasone or oral prednisolone. Sulfate as a STUDY POPULATION. Sixty-nine children aged 5 to 17 years Screening Test with a previous history of wheezing who presented to a Dorsey MJ, Cohen LE, Phipatanakul W, Denufrio D, tertiary care pediatric emergency department (ED) with Schneider LC. Ann Asthma Immunol. 2006;97: acute asthma and an FEV1 between 50% and 79% pre- 182–186 dicted. PURPOSE OF THE STUDY. To evaluate dehydroepiandrosterone METHODS. This randomized, double-blind, double-dummy sulfate (DHEA-S), a corticotropin-dependent adrenal trial randomly assigned patients to receive either 2 mg of androgen precursor, as a possible marker for adrenal fluticasone via metered-dose inhaler (MDI) in the ED function and hypothalamic-pituitary-adrenal axis sup- along with 500 ␮g of fluticasone via Diskus twice daily pression in children treated with inhaled corticosteroids for 5 days (n ϭ 35) or 2 mg/kg oral prednisolone in the (ICSs) compared with low-dose (0.5 ␮g/m2 up to 1.0 ␮g) ED along with 1 mg/kg prednisolone once daily for 5 and standard-dose (250 ␮g) cosyntropin-stimulation days (n ϭ 34). All children received scheduled, nebu- testing. lized albuterol and in the ED and STUDY POPULATION. Twenty-two patients with moderate-to- were given scheduled salmeterol and rescue albuterol on severe–persistent asthma receiving a medium-to-high ED discharge. FEV was measured at baseline, 4 hours, 1 dose of ICSs for at least 6 months were enrolled (defi- and 48 hours. nition of median-to-high dose of ICS: RESULTS. At 4 hours, the patients in the prednisolone group Ͼ400 ␮g/day or fluticasone Ͼ176 ␮g/day for children Ϯ Ͻ Ͼ ␮ Ն had a significantly greater increase in FEV1 (29.8% 6 years old or 200 g/day for those 6 years). Pa- 15.5%) compared with those in the fluticasone group tients had received no more than 2 courses of systemic (19.1% Ϯ 12.7%; P ϭ .001). By 48 hours, the difference in exposure of Ͻ10 days’ duration in the

FEV1 between the groups was no longer statistically signif- previous 6 months and no systemic corticosteroid in icant. In addition, the number of unscheduled asthma visits the 1 month before enrollment. The average age of the by 48 hours after ED discharge was significantly greater in patients was 8.6 years (range: 2–12 years). the fluticasone group (4 of 32) than the prednisolone METHODS. After a 12-hour fast, morning , cortico- group (0 of 34). tropin, DHEA-S, and fasting blood sugar levels were CONCLUSIONS. Children with mild-to-moderate acute asthma measured. Cortisol was measured after the stimulation improve faster on oral prednisolone than inhaled flutica- tests. A cortisol level of Յ18 ␮g/dL was considered ab- sone. normal (adrenal suppression).

S142 BEST ARTICLES RELEVANT TO PEDIATRIC ALLERGY AND IMMUNOLOGY Downloaded from www.aappublications.org/news by guest on September 30, 2021 Assessment of Adrenal Suppression in Children With Asthma Treated With Inhaled Corticosteroids: Use of Dehydroepiandrosterone Sulfate as a Screening Test Alan B. Goldsobel Pediatrics 2007;120;S142 DOI: 10.1542/peds.2007-0846SSS

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/120/Supplement_3/S142 .2 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Pharmacology http://www.aappublications.org/cgi/collection/pharmacology_sub Pulmonology http://www.aappublications.org/cgi/collection/pulmonology_sub Asthma http://www.aappublications.org/cgi/collection/asthma_subtopic Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on September 30, 2021 Assessment of Adrenal Suppression in Children With Asthma Treated With Inhaled Corticosteroids: Use of Dehydroepiandrosterone Sulfate as a Screening Test Alan B. Goldsobel Pediatrics 2007;120;S142 DOI: 10.1542/peds.2007-0846SSS

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/120/Supplement_3/S142.2

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2007 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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