Long-term beclomethasone dipropionate aerosol therapy in juvenile asthma

Francis, R. S.

doi:10.1016/0041-3879(75)90065-3

Cited by 8 publications

(12 citation statements)

References 1 publication

(1 reference statement)

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“…The direct influence of asthma on growth makes it difficult to assess the effects of corticosteroids in crosssectional studies, although the majority of these studies have shown no effect of inhaled corticosteroids [67][68][69][70][71][72][73][74][75][76]. Longitudinal studies have also generally failed to demonstrate any significant effect of inhaled corticosteroids on statural growth in doses up to 800 µg·day -1 for up to 5 yrs of treatment [62,[77][78][79].…”

Section: Effect Of Corticosteroids On Growthmentioning

confidence: 99%

Effect of inhaled corticosteroids on bones and growth

Efthimiou¹,

Barnes²

1998

Eur Respir J

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Asthma is a chronic inflammatory disease of the airways and current national and international asthma management guidelines advocate the early introduction of inhaled corticosteroids as the most effective anti-inflammatory therapy available [1][2][3][4]. However, inhaled corticosteroids are not entirely devoid of risk and their use in clinical practice entails a judgement that weighs the potential benefits against the risks of treatment [5][6]. The potential for systemic effects of inhaled corticosteroids is considered to be reflected in their activity of suppressing the hypothalamic-pituitary-adrenal (HPA) axis [7]. However, the clinical relevance of such suppression has been questioned [8] and concerns have been raised concerning the possible effects of inhaled corticosteroids on bones [9] and growth [10]. This review examines the effects of inhaled corticosteroids on bone metabolism, bone density and growth in adults and children with asthma, in view of the recent availability of a substantial amount of new information from clinical trials. Effect of corticosteroids on bone metabolismCorticosteroids may lead to a reduction in bone mass and osteopenia via several different mechanisms, including direct effects on bone formation and bone resorption and indirect effects via actions on the pituitary-gonadal and pituitary-adrenal axes, intestinal calcium absorption, renal tubular calcium reabsorption and secondary hyperparathyroidism ( fig. 1) [11]. A number of biochemical markers have been used to assess the short-term effects of inhaled corticosteroids on bone turnover [12] (table 1). Bone formation has been evaluated by measuring blood concentrations of bone-specific alkaline phosphatase, osteocalcin and procollagen type-1 carboxy-terminal and amino-terminal propeptides (P1CP and P1NP, respectively). Bone resorption has been evaluated by measuring urinary excretion of hydroxyproline, calcium and pyridinium cross-links and by serum levels of type-1 carboxy-terminal telopeptide (1CTP) and tartrate-resistant acid phosphatase. Examination of relevant retrospective and prospective data, involving 11 studies (1,240 patients) on biochemical bone markers and 14 studies (373 patients) on bone density over a wide dose range, have largely indicated no significant or clinically important effect on these measurements in adults or children with asthma. Markers of bone formation and resorption need to be measured concurrently for a reliable assessment of bone turnover to be made.Knemometry, measuring lower leg growth rate, is a sensitive technique for comparing the systemic activity of different inhaled corticosteroids, but does not relate to long-term growth. The majority of approximately 40 studies on inhaled corticosteroids and statural growth in children, over a wide recommended dose range, including a number of recent long-term, prospective studies, demonstrate little or no effect. Children taking above recommended doses of inhaled corticosteroids should have their growth monitored using stadiometry at least every 6 month...

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Section: Effect Of Corticosteroids On Growthmentioning

confidence: 99%

Effect of inhaled corticosteroids on bones and growth

Efthimiou¹,

Barnes²

1998

Eur Respir J

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“…'0 11 The effect of ICT on linear growth, is however, controversial. 3 [12][13][14] This study evaluated the effects of ICT and the severity of asthma on linear growth in prepubertal children with severe chronic bronchial asthma, many of whom were poorly controlled despite higher than conventionally recommended doses of ICT.…”

mentioning

confidence: 99%

Asthma, inhaled corticosteroid treatment, and growth.

Ninan

Russell

1992

Archives of Disease in Childhood

142

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To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0-01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1-50) and after (-1-55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth.

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“…Some of the children in the studies had received oral glucocorticosteroids until the inhaled therapy was introduced [50][51][52][53][54], and continued to do so intermittently [50,53]. In the study by TINKELMAN et al [58], the beclomethasone dipropionate-treated children were compared with theophylline-treated children, who grew somewhat faster than expected during the study period.…”

Section: Intermediate-term Growthmentioning

confidence: 99%

“…In the studies of beclomethasone dipropionate, the dose often varied and, in one study [51], the treatment was withdrawn for some months during the observation period. Some of the children in the studies had received oral glucocorticosteroids until the inhaled therapy was introduced [50][51][52][53][54], and continued to do so intermittently [50,53].…”

Section: Intermediate-term Growthmentioning

confidence: 99%

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Long-, intermediate- and short-term growth studies in asthmatic children treated with inhaled glucocorticosteroids

Wolthers¹

1996

Eur Respir J

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During recent years, new auxological techniques have been introduced for assessment of the risk of growth suppression in asthmatic children treated with exogeneous glucocorticosteroids. Assessment of lower leg growth rates with the knemometer has made short-term studies of growth processes under strictly controlled conditions possible. However, short-term lower leg growth rates cannot be used for estimations of intermediate-term height growth rates or long-term evaluations of final height. Consequently, the distinctions between the various types of growth studies in asthmatic children treated with inhaled glucocorticosteroids have become important and need to be discussed.The present paper presents a review of the long-, intermediate-and short-term growth studies available. The bulk of evidence from intermediate-and short-term evaluations indicates that growth rate is not affected when standard paediatric doses of inhaled glucocorticosteroids are used. However, further focus needs to be placed on differences between specific glucocorticosteroids, doses and delivery systems. Intermediate-and short-term growth data should be evaluated in the long-term perspective.

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Long-term beclomethasone dipropionate aerosol therapy in juvenile asthma

Cited by 8 publications

References 1 publication

Effect of inhaled corticosteroids on bones and growth

Effect of inhaled corticosteroids on bones and growth

Asthma, inhaled corticosteroid treatment, and growth.

Long-, intermediate- and short-term growth studies in asthmatic children treated with inhaled glucocorticosteroids

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