Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate

Lancet. 1996 Jul 6;348(9019):27-9. doi: 10.1016/s0140-6736(96)03339-9.


Background: Fluticasone propionate was introduced in 1993 in the UK as a potentially safer inhaled corticosteroid than those already in use. The efficacy and safety of fluticasone has been established at recommended doses of 200 micrograms/day, but not at higher doses that are often used.

Methods: Growth retardation was observed in six severely asthmatic children after introduction of high-dose fluticasone propionate treatment (dry powder). Assessment of cortisol response was by insulin-induced hypoglycaemia in three cases, by short tetracosactrin test in two, and by low-dose tetracosactrin and 24-hour urinary cortisol/creatinine ratio in one.

Findings: Six children with growth retardation noted after treatment with high-dose fluticasone propionate were found to have adrenal suppression. In one case the growth rate and cortisol response returned to normal 9 months after the fluticasone dose was reduced to 500 micrograms/day.

Interpretation: When high doses of fluticasone propionate are used, growth may be retarded and adrenal suppression may occur.

Publication types

  • Case Reports

MeSH terms

  • Administration, Topical
  • Adrenal Cortex / drug effects*
  • Androstadienes / administration & dosage*
  • Androstadienes / adverse effects*
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / adverse effects*
  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / adverse effects*
  • Asthma / drug therapy*
  • Child
  • Child, Preschool
  • Depression, Chemical
  • Female
  • Fluticasone
  • Glucocorticoids
  • Growth Disorders / chemically induced*
  • Humans
  • Male


  • Androstadienes
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Fluticasone