Oral Glucocorticoid Use and Morbidities Examined in Pediatrics

Potential adverse events of chronic oral glucocorticoid exposure include adrenal insufficiency, recurrent pneumonia, and GI disorders, and more.
Potential adverse events of chronic oral glucocorticoid exposure include adrenal insufficiency, recurrent pneumonia, and GI disorders, and more.

This article is part of MPR's coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.


Children with asthma who were treated with chronic oral glucocorticoids experienced significant morbidities, including adrenal suppression, recurrent pneumonia, and behavioral problems, according to research presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology and World Allergy Organization (AAAAI/WAO) in Orlando, Florida.

David P. Skoner, MD, from West Virginia University in Morgantown, and colleagues identified continuously enrolled privately insured children (ages 6 to 17 years) with asthma who did or did not initiate chronic oral glucocorticoids (>515-day continuous use) from 2009 to 2014. Patients with chronic oral glucocorticoid exposure or chronic possible adverse events 12 months before initiating oral glucocorticoids were excluded. Relative risks were adjusted for cumulative-dose inhaled corticosteroids, other prescription glucocorticoids (topical, inhaled, intravenous), number of International Classification of Diseases-9 diagnoses, number of national drug codes, demographics, and treatment year.

In 2376 oral glucocorticoid initiators (mean age, 10.5 years; 62.0% boys), the mean cumulative prednisone-equivalent exposure totaled 1125.5 mg/y and 21.8% used high-dose inhaled corticosteroids. In 7584 children without chronic oral glucocorticoid exposure (mean age, 10.5 years; 61.6% boys), the mean prednisone-equivalent exposure was 178.6 mg/y (oral corticosteroid bursts) and 12.2% used high-dose inhaled corticosteroids.

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The following possible adverse events were associated with chronic oral glucocorticoid exposure adrenal insufficiency (adjusted relative risk [aRR], 12.13), recurrent pneumonia (aRR, 1.97), gastrointestinal disorders (aRR, 1.68), persistent cough (aRR, 1.67), behavioral problems (aRR, 1.37), sleep disorders (aRR, 1.45), and sinusitis (aRR, 1.17).

In addition, the following possible adverse events were studied but did not reach statistical significance: bone-related events (fracture, osteoporosis, and osteopenia), fracture, hypertension, short stature, obesity, and oropharyngitis.

The researchers concluded that clinicians should consider alternative treatments to avoid these potential complications in appropriate patients with uncontrolled asthma.

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Reference

Skoner DP, Antonova EN, Kong AM, Lenhart G, Iqbal A, Teague WG. Morbidities associated with chronic oral glucocorticoid exposure in children with asthma: a real-world analysis of medical and pharmacy claims. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Abstract 689.