Peculiarities of bronchial asthma persistence in schoolchildren depending on adrenal cortisol-producing function

O.K. Koloskova, H.P. Buryniuk-Glovyak, N.M. Kretsu

Abstract


Background. Nowadays, inhalation glucocorticosteroids (IGCS) play a leading role in the treatment of bronchial asthma (BA), both on the stage of achieving and maintaining a complete control of clinical signs of the disease. IGCS administration in high doses is known to be associated with systemic side effects, one of the most troubled of which is inhibition of the functional activity of the hypothalamic-pituitary-adrenal system. Nevertheless, the peculiarities of the diseases course and changes of the adrenal cortisol-producing function in children receiving IGCS are not studied sufficiently. The purpose of the study was to examine clinical peculiarities of bronchial asthma in children receiving basic anti-inflammatory therapy with IGCS considering the state of the adrenal cortisol-producing function. Materials and methods. To achieve the purpose of the study, the cohort of 45 schoolchildren suffering from BA receiving IGCS as a part of basic therapy were examined comprehensively by means of simple random sampling. Peculiarities of BA course in patients were examined in two groups depending on the value of serum cortisol (SC) that was either lower than minimal value of the norm (< 50.0 ng/ml, 20 children), or higher than it (> 50.0 ng/ml, 25 patients). Results. The disease had a tendency to severe type of clinical manifestations in patients with low adrenal cortisol-producing function. In spite of the lack of statistically reliable differences by the markers concerning BA severity, the control indices according to the data of clinical-instrumental estimating scale appeared to be reliably worse in patients with the parameters of SC < 50.0 ng/ml, first of all at the expense of its clinical constituent. According to the data of clinical and epidemiological analysis, the risk of SC content more than 50.0 ng/ml (as a marker of preserved adrenal cortisol-producing function) was found with the use of low doses of IGCS — odds ratio of this event was 3.14, a relative risk — 1.5, and absolute risk — 0.26. At the same time, the use of average doses of IGCS was associated with inconsiderably high risk of inhibition of the adrenal cortisol-producing function (by the data of SC < 50.0 ng/ml): odds ratio — 3.14 (95% confidence interval (CI) 0.4–26.6), relative risk — 2.1 (95% CI 0.3–12.6), and absolute risk — 0.26. Conclusions. Therefore, the course of BA in schoolchildren with the content of serum cortisol less than 50.0 ng/ml is characterized by pronounced clinical signs of atopy with “accumulation” of comorbidity, more severe control of the disease with its longer duration. At the same time, 3.14 times lower doses of IGCS increase the probability of maintaining the adrenal cortisol-producing function, and average doses are associated with similar inhibition of this function.

Keywords


children; bronchial asthma; cortisol; adrenal glands

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DOI: https://doi.org/10.22141/2224-0721.13.2.2017.100600

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