Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate

Background Fluticasone propionate was introduced in 1993 in the UK as a potentially safer inhaled corticosteroid than those already in use. The efficacy and safety of fluticasone has been established at recommended doses of 200μg/day, but not at the higher doses that are often used. Methods Growth retardation was observed in six severely asthmatic children after introduction of high-dose fluticasone propionate treatment (dry powder). Assessment of cortisol response was by insulin-induced hypoglycaemia in three cases, by short tetracosactrin test in two, and by low-dose tetracosactrin and 24-hour urinary cortisol/ creatinine ratio in one. Findings Six children with growth retardation noted after treatment with high-dose fluticasone propionate were found to have adrenal suppression. In one case the growth rate and cortisol response returned to normal 9 months after the fluticasone dose was reduced to 500μg/day. Interpretation When high doses of fluticasone propionate are used, growth may be retarded and adrenal suppression may occur.