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Effect of intravenous hydrocortisone on nocturnal airflow limitation in childhood asthma

¹ Dept of Paediatrics, Rijnstate Hospital, Arnhem, ² Dept of Epidemiology, University of Groningen, and ³ Dept of Pulmonology, University Hospital, Groningen, and ⁴ Dept of Paediatric Pulmonology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands

CORRESPONDENCE: A.M. Landstra, Dept of Paediatrics, Rijnstate Hospital, PO box: 9555, 6800, TA Arnhem, the Netherlands. Fax: 31 263786147. E-mail: amlandstra@hetnet.nl

Keywords: asthma, children, serum cortisol

Received: September 16, 2002
Accepted November 11, 2002

This study was supported by the Dutch Asthma Foundation (Grant 94.115) and Stichting, Astma Bestrijding.

Low endogenous cortisol levels appear to contribute to the pathophysiology of nocturnal asthma. Lower cortisol levels are associated with lower forced expiratory volume in one second (FEV₁) levels in children with asthma. The aim of the present study was to identify whether substitution of low serum cortisol with intravenous hydrocortisone decreases 24-h FEV₁ variation and/or indirect measures of airway inflammation.

Hydrocortisone was given over 24 h in a double-blind randomised crossover design to 26 subjects. FEV₁ was measured every 4 h during 24 h; blood eosinophils and airway responsiveness to methacholine and adenosine 5'-monophosphate (AMP) were measured at 04:00 h and 16:00 h.

Cortisol levels increased during the night and morning hours. FEV₁ values were higher at all time points in children with nocturnal asthma (n=10; 24-h FEV₁ variation 15%) which was significant at 08:00 h, unlike in the non-nocturnal asthma (NA–) group (n=16). Numbers of eosinophils (10⁹·L^–1) at 04:00 h decreased in the asthma group (median 0.61 (range 0.05–1.42) versus 0.52 (0.05–1.79)). Provocative dose causing a 20% fall in FEV₁ (PD₂₀) methacholine did not change, whereas PD₂₀ AMP improved only at 16:00 h in the NA– group (72.0 (0.13–144.0) versus 144.0 (2.25–144.0) mg·mL^–1).

These results show that substitution of lower endogenous 24-h values of cortisol contribute to higher forced expiratory volume in one second values and a decrease of blood eosinophils as an inflammatory marker in more severe airway obstruction.