A significantly lower hair cortisol concentration (HCC) was observed in patients with asthma compared with healthy controls, suggesting that HCC measurement may be used to detect individuals at risk for hypocortisolism, according to the results of a cross-sectional observational study published in Pediatric Pulmonology.

While inhaled corticosteroids (ICS) are the first line of maintenance therapy for asthma and are generally considered to be safe, side effects occur in some patients, and in children, adrenal crisis has been documented. Measurement of HCC is a noninvasive method to measure adrenal function that may have potential for monitoring patients with asthma who are on long-term ICS treatment.

Thus, researchers obtained hair samples from 72 patients with asthma and 226 patients without asthma (age, 6-21 years) and found that the median HCC was significantly lower in patients with asthma (1.83 pg/mg) compared with patients without asthma (2.39 pg/mg; adjusted for age, sex, and body mass index z score: P =.0.36). In addition, the median HCC was 1.98 pg/mg in patients with asthma not using ICS, 1.84 pg/mg in patients with asthma receiving low-dose ICS, 1.75 pg/mg in those receiving a medium dose, and 1.46 in those receiving a high ICS dose (adjusted for age, sex, and body mass index z score: P =.54).

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“To conclude, in this study we demonstrated that children with asthma have lower HCC than children without asthma, possibly due to adrenal suppression caused by ICS use,” the researchers wrote. “Whether HCC can be used as a monitoring tool to predict the risk of hypocortisolism in children with asthma needs to be further explored.”


Baan EJ, van den Akker ELT, Engelkes M, et al. Hair cortisol and inhaled corticosteroid use in asthmatic children [published online October 25, 2019]. Pediatr Pulmonol. doi:10.1002/ppul.24551