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İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi

Year 2023, Volume: 7 Issue: 2, 165 - 170, 07.08.2023
https://doi.org/10.46332/aemj.1179770

Abstract

Amaç: Astım sık hastane başvurusu, ilaç kullanımı ve yaşam kalitesi bozukluğuna neden olan kronik bir hastalıktır. Astım tedavisinde kullanılan inhale kortikosteroidlerin (İKS) insülin direnci üzerindeki etkisi ile ilgili yeterince çalışma bulunmamaktadır. Bu çalışmada, prepubertal dönemde İKS kullanan astımlı çocuklarda İKS’nin insülin direnci üzerindeki etkisini araştırmak amaçlandı.

Araçlar ve Yöntem: Çalışmaya en az 1 ay idame astım tedavisi alan astımlı çocuklar ve sağlıklı çocuklar dâhil edildi. Hastaların açlık glikoz, açlık insülin, VKİ ve Homeostatis model assesment insülin resistansı (HOMA-IR) değerleri karşılaştırıldı.

Bulgular: Çalışmaya 117 astımlı çocuk ve 103 sağlıklı çocuk olmak üzere toplam 220 kişi dahil edildi. Astımlı çocuklar aldıkları idame tedaviye göre İKS grubu (n=60) ve montelukast grubu (n=57) olarak ikiye ayrıldı. Grupların demografik bulguları arasında istatiksel anlamlı fark yok idi. Astımlı hastalarda kullanılan total kümülatif inhale kortikosteroid dozları karşılaştırıldığında İKS grubunda medyan 40 (7.75-1090) mg iken montelukast grubunda medyan 3.75 (0-50) mg olarak tespit edildi (p<0.01).
Grupların açlık glikoz ve açlık insülin düzeyleri ve HOMA-IR düzeyleri benzer saptandı. İKS grubunda açlık glikoz, açlık insülin, VKİ, IgE ve deri prik testi ile kortikosteroid dozları arasında istatistiksel olarak anlamlı bir ilişki bulunmadı. Ancak HOMA-IR ile idame kümülatif ve total kümülatif kortikosteroid dozu arasında pozitif ilişki saptandı (p= 0.017).

Sonuç: Çalışmada astımlı çocukların kullandığı kümülatif kortikosteroid miktarı ile insülin rezistansı arasında pozitif ilişki olduğu saptandı. Astımlı çocuklarda uzun süreli ve yüksek dozda kortikosteroid kullanımının insülin direncine neden olacağını düşünülmektedir.

References

  • 1. Papadopoulos NG, Arakawa H, Carlsen KH, et al. International consensus on (ICON) pediatric asthma. Allergy. 2012;67(8):976-997.
  • 2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. www.ginasthma.org. Erişim tarihi 1 Ağustos, 2022.
  • 3. Kurtoglu S, Hatipoglu N, Mazcoglu M, Kendirci M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-106.
  • 4. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
  • 5. Heffler E, Madeira LNG, Ferrando M, et al. Inhaled Corticosteroids Safety and Adverse Effects in Patients with Asthma. J Allergy Clin Immunol Pract. 2018;6(3):776-781.
  • 6. Arshi M, Cardinal J, Hill RJ, Davies PSW, Wainwright C. Asthma and insulin resistance in children. Respirology. 2010;15(5):779-784.
  • 7. Derendorf H, Nave R, Drollmann A, Cerasoli F, Wurst W. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. Eur Respir J. 2006;28(5):1042-1050.
  • 8. Zöllner EW, Lombard CJ, Galal U, Hough FS, Irusen EM, Weinberg E. Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children. Pediatrics. 2012;130(6):e1512-e1519.
  • 9. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Ocular, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients. J Am Acad Dermatol. 2017;76(2):201-207.
  • 10. Cavkaytar O, Vuralli D, Arik Yilmaz E, et al. Evidence of hypothalamic-pituitary-adrenal axis suppression during moderate-to-high-dose inhaled corticosteroid use. Eur J Pediatr. 2015;174(11):1421-1431.
  • 11. Peters MC, Schiebler M, Cardet JC, et al. The Impact of Insulin Resistance on Loss of Lung Function and Response to Treatment in Asthma. Am J Respir Crit Care Med. 2022;206(9).1096-1106.
  • 12. Sánchez Jiménez J, Herrero Espinet FJ, Mengibar Garrido JM, et al. Asthma and insulin resistance in obese children and adolescents. Pediatr Allergy Immunol. 2014;25(7):699-705.
  • 13. Goyal JP, Kumar P, Thakur C, Khera D, Singh K, Sharma P. Effect of insulin resistance on lung function in asthmatic children. J Pediatr Endocrinol Metab. 2021;35(2):217-222.
  • 14. Carr TF, Granell R, Stern DA, et al. High Insulin in Early Childhood Is Associated with Subsequent Asthma Risk Independent of Body Mass Index. J Allergy Clin Immunol Pract. 2022;10(3):785-792.

The Effect of Inhaled Corticosteroids on Insulin Resistance in Prepubertal Children with Asthma

Year 2023, Volume: 7 Issue: 2, 165 - 170, 07.08.2023
https://doi.org/10.46332/aemj.1179770

Abstract

Purpose: Asthma is a chronic disease that causes frequent hospital admissions, medication use and impaired quality of life. The purpose of this study was to investigate the effect on insulin resistance of ICS in children with asthma using ICS in the prepubertal period.

Materials and Methods: Asthmatic children receiving at least one month of maintenance asthma treatment and healthy children were included in the study. Patients’ fasting glucose, fasting insulin, BMI, and homeostasis model assessment insulin resistance (HOMA-IR) values were compared.

Results: Two hundred twenty individuals were included in the study, 117 asthmatic and 103 healthy children. The children with asthma were divided into two groups depending on the maintenance treatment received-ICS (n=60) and montelukast (n=57).
The median total cumulative inhaled corticosteroid doses were 40 mg (7.75-1090) in the ICS group and 3.75 mg (0-50) in the montelukast group (p<0.01). The groups’ fasting glucose, fasting insulin, and HOMA-IR levels were similar. It has been revealed no statistically significant relationship between fasting glucose, fasting insulin, BMI, IgE, or the skin prick test and corticosteroid doses in the ICS group. However, a positive correlation was found between HOMA-IR and maintenance cumulative and total cumulative corticosteroid doses (p=0.017).

Conclusion: A positive correlation was determined between the cumulative amount of corticosteroid used by children with asthma and insulin resistance. We think that prolonged and high-dose corticosteroid use by children with asthma will cause insulin resistance.

References

  • 1. Papadopoulos NG, Arakawa H, Carlsen KH, et al. International consensus on (ICON) pediatric asthma. Allergy. 2012;67(8):976-997.
  • 2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. www.ginasthma.org. Erişim tarihi 1 Ağustos, 2022.
  • 3. Kurtoglu S, Hatipoglu N, Mazcoglu M, Kendirci M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-106.
  • 4. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
  • 5. Heffler E, Madeira LNG, Ferrando M, et al. Inhaled Corticosteroids Safety and Adverse Effects in Patients with Asthma. J Allergy Clin Immunol Pract. 2018;6(3):776-781.
  • 6. Arshi M, Cardinal J, Hill RJ, Davies PSW, Wainwright C. Asthma and insulin resistance in children. Respirology. 2010;15(5):779-784.
  • 7. Derendorf H, Nave R, Drollmann A, Cerasoli F, Wurst W. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. Eur Respir J. 2006;28(5):1042-1050.
  • 8. Zöllner EW, Lombard CJ, Galal U, Hough FS, Irusen EM, Weinberg E. Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children. Pediatrics. 2012;130(6):e1512-e1519.
  • 9. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Ocular, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients. J Am Acad Dermatol. 2017;76(2):201-207.
  • 10. Cavkaytar O, Vuralli D, Arik Yilmaz E, et al. Evidence of hypothalamic-pituitary-adrenal axis suppression during moderate-to-high-dose inhaled corticosteroid use. Eur J Pediatr. 2015;174(11):1421-1431.
  • 11. Peters MC, Schiebler M, Cardet JC, et al. The Impact of Insulin Resistance on Loss of Lung Function and Response to Treatment in Asthma. Am J Respir Crit Care Med. 2022;206(9).1096-1106.
  • 12. Sánchez Jiménez J, Herrero Espinet FJ, Mengibar Garrido JM, et al. Asthma and insulin resistance in obese children and adolescents. Pediatr Allergy Immunol. 2014;25(7):699-705.
  • 13. Goyal JP, Kumar P, Thakur C, Khera D, Singh K, Sharma P. Effect of insulin resistance on lung function in asthmatic children. J Pediatr Endocrinol Metab. 2021;35(2):217-222.
  • 14. Carr TF, Granell R, Stern DA, et al. High Insulin in Early Childhood Is Associated with Subsequent Asthma Risk Independent of Body Mass Index. J Allergy Clin Immunol Pract. 2022;10(3):785-792.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences, Clinical Sciences (Other)
Journal Section Original Articles
Authors

Hayrunnisa Bulut Yıldız This is me 0000-0002-8671-2791

Zülfikar Akelma 0000-0003-0140-5053

Sacit Günbey This is me 0000-0001-7304-9129

Early Pub Date July 5, 2023
Publication Date August 7, 2023
Published in Issue Year 2023 Volume: 7 Issue: 2

Cite

APA Bulut Yıldız, H., Akelma, Z., & Günbey, S. (2023). İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi. Ahi Evran Medical Journal, 7(2), 165-170. https://doi.org/10.46332/aemj.1179770
AMA Bulut Yıldız H, Akelma Z, Günbey S. İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi. Ahi Evran Med J. August 2023;7(2):165-170. doi:10.46332/aemj.1179770
Chicago Bulut Yıldız, Hayrunnisa, Zülfikar Akelma, and Sacit Günbey. “İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi”. Ahi Evran Medical Journal 7, no. 2 (August 2023): 165-70. https://doi.org/10.46332/aemj.1179770.
EndNote Bulut Yıldız H, Akelma Z, Günbey S (August 1, 2023) İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi. Ahi Evran Medical Journal 7 2 165–170.
IEEE H. Bulut Yıldız, Z. Akelma, and S. Günbey, “İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi”, Ahi Evran Med J, vol. 7, no. 2, pp. 165–170, 2023, doi: 10.46332/aemj.1179770.
ISNAD Bulut Yıldız, Hayrunnisa et al. “İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi”. Ahi Evran Medical Journal 7/2 (August 2023), 165-170. https://doi.org/10.46332/aemj.1179770.
JAMA Bulut Yıldız H, Akelma Z, Günbey S. İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi. Ahi Evran Med J. 2023;7:165–170.
MLA Bulut Yıldız, Hayrunnisa et al. “İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi”. Ahi Evran Medical Journal, vol. 7, no. 2, 2023, pp. 165-70, doi:10.46332/aemj.1179770.
Vancouver Bulut Yıldız H, Akelma Z, Günbey S. İnhale Kortikosteroidlerin Prepubertal Astımlı Çocuklarda İnsülin Direnci Üzerine Etkisi. Ahi Evran Med J. 2023;7(2):165-70.

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