Reply: Evaluation of hypothalamic-pituitary-adrenal axis (ΗΡΑ) suppression by low-dose (0.5 μg) and standard-dose (250 μg) adrenocorticotropic hormone (ACTH) tests in asthmatic children treated with inhaled corticosteroid (JPEM 2006; 19: 1015-1023)

We read with interest the study by Ozbek et al.. The authors showed that certain susceptible asthmatic patients exhibit adrenal suppression over a period of 8 weeks on inhaled budesonide (BUD), and that the low-dose test (LDT) is more sensitive than the standard-dose one (SDT) in detecting such patients. Our recently published data on 41 prepubertal asthmatic children who were tested by the LDT before and after 6 and 12 months of treatment with BUD (400 μΒ/day) are in agreement with their results. Interestingly, four (9.8%) of our patients had a decreased adrenal response before starting BUD treatment and showed improved adrenal responses while on BUD. In addition, although 22% of our patients showed decreased Cortisol response to LDT, when these patients were excluded from analysis, the remaining patients exhibited a significant improvement of peak Cortisol values from baseline throughout the 12month period. Our interpretation of these intriguing observations was that asthma inflammation per se may cause a decrease in Cortisol response to the LDT.