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Article Reviews and Commentary

Safety Profile of Frequent Short Courses of Oral Glucocorticoids in Acute Pediatric Asthma: Impact on Bone Metabolism, Bone Density and Adrenal Function.
Ducharme Chabot, Ploychronakos et al. Pediatrics 2003;111:376-383

In this cross-sectional study, the authors compared bone density, bone metabolism and adrenal function in children who were and were not exposed to bursts of oral glucocorticoids. Eighty-three children were enrolled (48 exposed, 35 unexposed). Exposure was defined as >/= 2 courses of oral glucorticoids within the previous year. The median exposure level was 4 courses of oral glucorticoids with a range of 3-11 courses in the preceding year. One month after an exacerbation of asthma for which oral glucocorticoids were prescribed measurements were made. Serum cortisol response to ACTH administration was tested. In addition, mean bone density z score determined and bone metabolism was measured using a variety of serum measurements. No cases of abnormal response to adrenocorticotrophic hormone suggestive of adrenal insufficiency were documented in either group, bone density z scores did not differ between the two groups and bone metabolism was also similar in the two groups.

Commentary
Thomas J. Mancuso, MD, FAAP

Peri-anesthetic administration of cortisol to patients who have been exposed to exogenous steroids in the recent past is firmly rooted in clinical and supported by precious little data. In this paper, the authors show that children administered oral glucocorticoids many times in a year did not show abnormalities in adrenal function, bone density or bone metabolism. Do these data indicate the safety of peri-anesthetic administration of another dose of steroids or do they indicate that such administration is not necessary?

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