Inhaled corticosteroids in children with persistent asthma: effects on growth

Zhang, Linjie; Prietsch, Sílvio O. M.; Ducharme, Francine M

doi:10.1002/ebch.1988

Cited by 45 publications

(22 citation statements)

References 100 publications

(17 reference statements)

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“…[ 68 – 71 , 74 – 76 ] Most notably, a recent Cochrane meta analysis of 25 trials involving 8471 children, found a mean decrease of 0.48cm/year in linear growth velocity and 0.61cm decrease from baseline height associated with regular use of all ICS at low and medium doses for one year but was extinguished in subsequent treatment years. [ 77 ] Our observation of decreased growth velocity and suppression in children exposed to flucticasone propionate and belcomethasone is in keeping with published literature.…”

Section: Discussionsupporting

confidence: 90%

A systematic review of adverse drug events associated with administration of common asthma medications in children

et al. 2017

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ObjectiveTo systematically review the literature and determine frequencies of adverse drug events (ADE) associated with pediatric asthma medications.MethodsFollowing PRISMA guidelines, we systematically searched six bibliographic databases between January 1991 and January 2017. Study eligibility, data extraction and quality assessment were independently completed and verified by two reviewers. We included randomized control trials (RCT), case-control, cohort, or quasi-experimental studies where the primary objective was identifying ADE in children 1 month– 18 years old exposed to commercial asthma medications. The primary outcome was ADE frequency.FindingsOur search identified 14,540 citations. 46 studies were included: 24 RCT, 15 cohort, 4 RCT pooled analyses, 1 case-control, 1 open-label trial and 1 quasi-experimental study. Studies examined the following drug classes: inhaled corticosteroids (ICS) (n = 24), short-acting beta-agonists (n = 10), long-acting beta-agonists (LABA) (n = 3), ICS + LABA (n = 3), Leukotriene Receptor Antagonists (n = 3) and others (n = 3). 29 studies occurred in North America, and 29 were industry funded. We report a detailed index of 406 ADE descriptions and frequencies organized by drug class. The majority of data focuses on ICS, with 174 ADE affecting 13 organ systems including adrenal and growth suppression. We observed serious ADE, although they were rare, with frequency ranging between 0.9–6% per drug. There were no confirmed deaths, except for 13 potential deaths in a LABA study including combined adult and pediatric participants. We identified substantial methodological concerns, particularly with identifying ADE and determining severity. No studies utilized available standardized causality, severity or preventability assessments.ConclusionThe majority of studies focus on ICS, with adrenal and growth suppression described. Serious ADE are relatively uncommon, with no confirmed pediatric deaths. We identify substantial methodological concerns, highlighting need for standardization with future research examining pediatric asthma medication safety.

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Section: Discussionsupporting

confidence: 90%

A systematic review of adverse drug events associated with administration of common asthma medications in children

et al. 2017

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“…There are over 6.2 million children with asthma in the United States and the prevalence is rising [5, 34]. Inhaled glucocorticoids are currently the first-line treatment for persistent asthma in both children and adults, with clear, demonstrated benefits to controlling asthma symptoms, improving quality of life, and reducing airway inflammation, hospitalizations, and asthma-related deaths [35]. The average age of an asthma diagnosis is 2.6 years [36].…”

Section: Skeletal Effects Of Inhaled Glucocorticoids In Pediatric Astmentioning

confidence: 99%

“…Initiation of inhaled glucocorticoids at a young age has potential effects on bone accrual, peak bone mass and growth in addition to the cumulative lifetime effects of these medications. Of concern are recent studies in pediatric populations, which have demonstrated detrimental effects of these medications on bone growth and density [35, 37, 38]. …”

Section: Skeletal Effects Of Inhaled Glucocorticoids In Pediatric Astmentioning

confidence: 99%

“…A meta-analysis of 25 trials involving 8471 children with mild to moderate, persistent asthma showed that inhaled glucocorticoid treatment produced a significant mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm deficit from baseline height after one year [35]. During the second year of treatment (included in five of the trials), there was no significant difference in linear growth velocity.…”

Section: Skeletal Effects Of Inhaled Glucocorticoids In Pediatric Astmentioning

confidence: 99%

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The Skeletal Effects of Inhaled Glucocorticoids

Sutter

Stein

2016

Curr Osteoporos Rep

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The skeletal effects of inhaled glucocorticoids are poorly understood. Children with asthma treated with inhaled glucocorticoids have lower growth velocity, bone density, and adult height. Studies of adults with asthma have reported variable effects on BMD, although prospective studies have demonstrated bone loss after initiation of inhaled glucocorticoids in premenopausal women. There is a dose response relationship between inhaled glucocorticoids and fracture risk in asthmatics; the risk of vertebral and non-vertebral fractures is greater in subjects treated with the highest doses in the majority of studies. Patients with COPD have lower BMD and higher fracture rates compared to controls, however, the majority of studies have not found an additional detrimental effect of inhaled glucocorticoids on bone. While the evidence is not conclusive, it supports using the lowest possible dose of inhaled glucocorticoids to treat patients with asthma and COPD and highlights the need for further research on this topic.

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“…These pediatric drug safety concerns are not limited to pharmaceuticals, but can also be critical when food or environmental toxicants are “unintended drugs” in developing children (Donohue et al 2013; Du Toit et al 2015; Gascon et al 2015; Midoro-Horiuti et al 2010; Miller and Peden 2014; Petzold et al 2014; Strobel and Ferguson 1984). Another consideration for pediatric safety assessment and study design is the increasing use of long-term pharmaceutical interventions, where continuous exposure may result in differential toxicities over the lifetime of the individual (Belvisi et al 2005; Pedersen et al 2010; Pruteanu et al 2014; Zhang, Prietsch, and Duchame 2014). …”

Section: Opening Remarks and Clinical Regulatory And Toxicology Permentioning

confidence: 99%

Juvenile Toxicology

Remick¹,

Catlin

Quist

et al. 2015

Toxicol Pathol

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The Society of Toxicologic Pathology (STP) Education Committee and the STP Reproductive Special Interest Group held a North Carolina regional meeting entitled, “Juvenile Toxicology: Relevance and Challenges for Toxicologists and Pathologists” on March 13, 2015, at the National Institute of Environmental Health Sciences/National Toxicology Program in Research Triangle Park, North Carolina. The purpose of this regional meeting was to familiarize attendees with the topic of juvenile toxicity testing and discuss its relevance to clinical pediatric medicine, regulatory perspectives, challenges of appropriate study design confronted by toxicologists, and challenges of histopathologic examination and interpretation of juvenile tissues faced by pathologists. The 1-day meeting was a success with over 60 attendees representing industry, government, research organizations, and academia.

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Inhaled corticosteroids in children with persistent asthma: effects on growth

Cited by 45 publications

References 100 publications

A systematic review of adverse drug events associated with administration of common asthma medications in children

A systematic review of adverse drug events associated with administration of common asthma medications in children

The Skeletal Effects of Inhaled Glucocorticoids

Juvenile Toxicology

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