Aim We aimed to analyse the efficacy and side effects of intra-muscular triamcinolone as a therapy in ‘difficult to control’ asthma in children.
Methods A retrospective case note review for all children who attended the difficult to control asthma clinic and received intra-muscular triamcinolone since 2004.
Results We identified 7 children (mean age 12 years; range 8-16 years; 6 F:1 M) who had at least 2 doses of triamcinolone. Two patients, who appeared to respond, had prolonged course of 16 and 21 doses respectively. The maximum dose used was 60 mg but most doses were 40 mg or less. There was no improvement in 2 patients and it was stopped after 3 and 5 months. 3/7 patients reported symptomatic benefits. 2/7 patients had no hospital admissions and 3/7 had reduced exacerbations. In 5/6 FEV1 showed significant improvement (mean FEV1 before treatment 1.77 L compared to 2.22 L after (p =0.02)).
All patients reported significant side effects. 2/7 patients reported symptoms suggestive of adrenal suppression 1-2 weeks prior to the next injection. 4/7 patients required replacement hydrocortisone during (1/4) and after treatment. Other side effects were common; significant weight loss 3/7/; hirsutism 4/7; localised bruising or fat atrophy at injection site 3/7. 2 patients had dysmenorrhoea and 3 patients had cushingoid features. Of note, 4/7 reported increased mood swings and low mood resulting in therapy being abandoned in 2 cases. One patient on prolonged maintenance developed steroid induced myopathy.
Conclusion Intramuscular traimcinolone therapy has been reported to be an effective short-term treatment for difficult asthma in children, particularly in establishing whether the asthma is steroid responsive1. This case review confirms that it can be used to establish whether asthma is steroid responsive. More importantly it highlights that there is a very significant side-effect profile, especially if use is prolonged, which may outweigh clinical benefits. We propose that any use of triamcinolone must be considered cautiously with a clear explanation of likely side effects and only should be initiated in close conjunction with endocrinology to anticipate and manage complications related to adrenal suppression.
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