Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

INTRODUCTION: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. METHOD: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). RESULTS: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). CONCLUSION: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? / Uso de corticosteroides orais nas exacerbações da asma pode estar associado à supressão adrenal: os médicos estão alertas?

Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.

Resumo Introdução: A corticoterapia oral (CO) é um dos pilares do tratamento na exacerbação da asma, e cursos de curta duração são geralmente considerados seguros. No entanto, crianças submetidas a repetidos cursos estão sujeitas a disfunção do eixo hipotálamo-hipófise-adrenal (HHA). Objetivo: Investigar a integridade do eixo HHA em crianças com asma persistente ou sibilância recorrente com indicação para corticoterapia inalatória (CI). Método: Avaliação do cortisol sérico basal antes da introdução da CI e 30, 60 e 90 dias após iniciado o tratamento, utilizando-se o imunoensaio ImmuliteÒ Siemens Medical Solutions Diagnostic chemiluminescent (Los Angeles, EUA; 2006). Resultados: Das 140 crianças avaliadas (0,3 a 15 anos de idade) com asma persistente ou sibilância recorrente, 40% relataram ter recebido CO no último mês antes da avaliação. Cerca de 12,5% delas apresentaram supressão adrenal bioquímica e evoluíram com recuperação do eixo HHA durante os primeiros três meses em CI. O número de dias livres de CO e a duração do último curso antes da avaliação do cortisol não foram significativamente diferentes entre as crianças com ou sem supressão adrenal (p=0,29 e p=0,20, respectivamente). O número de cursos de curta duração relatados no ano anterior à avaliação também não esteve associado à supressão adrenal (p=0,89). Conclusão: A utilização dos corticosteroides nas doses convencionais, em cursos de curta duração, pode colocar as crianças em risco de disfunção do eixo HHA. A recuperação desse eixo é possível durante a CI. Profissionais de saúde devem estar atentos para a possibilidade de resposta inadequada ao estresse durante o acompanhamento de crianças com asma persistente ou sibilância recorrente.

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy.

OBJECTIVE: There is elevated morbidity associated with asthma, particularly in developing countries, and failure to comply with inhaled corticosteroid treatment contributes to this morbidity. The objective of this study is to compare rates of compliance with beclomethasone treatment reported by parents or guardians with those measured by pharmacy dispensing records. METHODS: A concurrent cohort study of 12 months' duration was carried out, enrolling 106 asthmatic children and adolescents, selected at random. Linear regression was used to compare rates of compliance reported by parents or guardians with the pharmacy dispensing records at the service, every 4 months after enrollment on the study. RESULTS: Compliance rates reported by parents and/or guardians were always higher (p < 0.001) and exhibited a weak correlation with pharmacy records during the period studied; fourth (r = 0.37) and twelfth (r = 0.31) months of follow-up. CONCLUSIONS: The rates of compliance reported by parents were overestimated during all study periods. The compliance rates of children with asthma should also be monitored by other methods and, in this case, pharmacy records effectively revealed compliance failures. Given its low cost, this method is indicated for verification of these compliance rates.

Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test.

OBJECTIVES: Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS: Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS: We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS: The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Diagnóstico precoce das faringoamigdalites estreptocócicas: avaliação pelo teste de aglutinação de partículas de látex / Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test

OBJETIVOS: A faringoamigdalite aguda é uma das doenças mais freqüentes na prática pediátrica, sendo o estreptococo beta-hemolítico do grupo A (EBHGA) o agente etiológico bacteriano mais comum. O seu diagnóstico e tratamento adequados são importantes principalmente para a prevenção de seqüelas não-supurativas. Testes rápidos de detecção de antígenos do estreptococo do grupo A são uma ferramenta útil no diagnóstico das faringoamigdalites estreptocócicas, pela rapidez dos resultados, acurácia e baixo custo; no entanto, são pouco utilizados em nosso meio e pouco estudados em nosso país. O objetivo deste estudo foi avaliar a acurácia de um kit de teste rápido de detecção de antígeno do EBHGA comparado à cultura de suabe de orofaringe. MÉTODOS: Foram selecionadas crianças de 1 a 18 anos com diagnóstico clínico de faringoamigdalite aguda em serviços públicos de urgência e clínica privada de Belo Horizonte (MG), sendo excluídas as que haviam utilizado antibióticos até 30 dias antes da consulta. A amostra final incluiu 229 pacientes, que foram submetidos a coleta de dois suabes de orofaringe, um para o teste rápido para EBHGA e o outro enviado para cultura. RESULTADOS: Encontrou-se sensibilidade de 90,7 por cento, especificidade de 89,1 por cento, valor preditivo positivo de 72,1 por cento, valor preditivo negativo de 96,9 por cento e razão de verossimilhança positiva de 9,0 para o teste rápido utilizado comparado à cultura. CONCLUSÃO: O teste rápido utilizado apresentou boa correlação com a cultura, sendo, portanto, de grande utilidade na prática clínica para detecção do EBHGA.

OBJECTIVES: Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS: Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS: We observed sensitivity of 90.7 percent, specificity of 89.1 percent, a positive predictive value of 72.1 percent, a negative predictive value of 96.9 percent and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS: The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Adesão ao uso de corticóide inalatório na asma: taxas relatadas pelos responsáveis e mensuradas pela farmácia / Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

OBJETIVO: A morbidade associada à asma é elevada, principalmente nos países em desenvolvimento, e as falhas na adesão ao uso de corticóide inalatório contribuem para esta elevação. Este estudo objetiva comparar as taxas de adesão ao uso de beclometasona relatadas pelos responsáveis e as mensuradas pelos registros de dispensação farmacêutica do medicamento. MÉTODOS: Foi realizado um estudo de coorte concorrente com duração de 12 meses, do qual participaram 106 crianças e adolescentes asmáticos, selecionados aleatoriamente. Através da regressão linear, as taxas de adesão relatadas pelos responsáveis e pelos registros de dispensação da farmácia do serviço foram correlacionadas, quadrimestralmente, a partir da admissão no estudo. RESULTADOS: As taxas de adesão relatadas pelos pais e/ou responsáveis foram sempre superiores (p < 0,001) e apresentaram fraca correlação com aquelas mensuradas pelos registros de farmácia nos períodos estudados, quarto (r = 0,37) e 12º (r = 0,31) mês do seguimento.CONCLUSÃO: As taxas de adesão relatadas pelos pais foram superestimadas em todos os períodos do estudo. Crianças com asma deveriam ter suas taxas de adesão também monitoradas por outros métodos e, neste caso, os registros de farmácia foram efetivos em revelar as falhas na adesão. Dado ao seu baixo custo, esse método está indicado para a verificação dessas taxas.

OBJECTIVE: There is elevated morbidity associated with asthma, particularly in developing countries, and failure to comply with inhaled corticosteroid treatment contributes to this morbidity. The objective of this study is to compare rates of compliance with beclomethasone treatment reported by parents or guardians with those measured by pharmacy dispensing records. METHODS: A concurrent cohort study of 12 months' duration was carried out, enrolling 106 asthmatic children and adolescents, selected at random. Linear regression was used to compare rates of compliance reported by parents or guardians with the pharmacy dispensing records at the service, every 4 months after enrollment on the study. RESULTS: Compliance rates reported by parents and/or guardians were always higher (p < 0.001) and exhibited a weak correlation with pharmacy records during the period studied; fourth (r = 0.37) and twelfth (r = 0.31) months of follow-up. CONCLUSIONS: The rates of compliance reported by parents were overestimated during all study periods. The compliance rates of children with asthma should also be monitored by other methods and, in this case, pharmacy records effectively revealed compliance failures. Given its low cost, this method is indicated for verification of these compliance rates.