Long‐term Treatment with Glucocorticoids/ACTH in Asthmatic Children III.

Oberger, E; Engström, Ingemar; Karlberg, Johan

doi:10.1111/j.1651-2227.1990.tb11335.x

Cited by 37 publications

(18 citation statements)

References 15 publications

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“…Furthermore, clinicians must be alert for the possibility of drug-induced growth suppression so as not to misattribute it to growth suppression related to other causes. [23][24][25][26] To minimize the risks of systemic corticosteroid exposure, including growth suppression, dose-reduction strategies (eg, allergen-avoidance measures, immunotherapy and concomitant treatment with antihistamines, or decongestants) should be considered. 27 In addition, many allergic rhinitis patients also receive corticosteroids via other routes for the treatment of concomitant disorders, such as asthma or atopic dermatitis.…”

Section: Discussionmentioning

confidence: 99%

Detection of Growth Suppression in Children During Treatment With Intranasal Beclomethasone Dipropionate

Rachelefsky²,

et al. 2000

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ABSTRACT. Objective. Intranasal beclomethasone dipropionate (BDP) has generally been considered to have no systemic activity at recommended doses, but the potential for long-term effects on growth has not previously been evaluated. This study was undertaken to assess the effects of 1 year of treatment with intranasal BDP on growth in children.Study Design. In this double-blind, randomized, parallel-group study, 100 prepubertal children 6 to 9 years old with perennial allergic rhinitis were treated with aqueous BDP 168 g twice daily (n ‫؍‬ 51) or placebo (n ‫؍‬ 49) for 1 year. Subjects' baseline heights were required to be between the 5th and 95th percentile, and skeletal age as determined by left wrist radiograph was required to be within 2 years of chronological age. Washout periods for medications known to affect growth, including other forms of corticosteroids, were established, and these medications were prohibited during the study. However, short courses of oral prednisolone lasting no more than 7 days, and short courses of dermatologic corticosteroids lasting no more than 10 days, were allowed. Height was measured with a stadiometer after 1, 2, 4, 6, 8, 10, and 12 months of treatment. The hypothalamic-pituitary-adrenocortical axis was assessed by measurements of 8 AM basal cortisol concentrations and response to .25 mg cosyntropin stimulation.The primary safety parameter was the rate of change in standing height. Statistical analyses were based on all randomized subjects who received at least 1 dose of medication (intent-to-treat principle). The rate of change in standing height was analyzed for all subjects who entered the study and for those completing the full 12 months of treatment (n ‫؍‬ 80). The rate of change in standing height over the 1-year study was calculated as the slope of a linear regression line fitted to each subject's height measurements over time. Because there was a statistically significant between-group difference in standing height at baseline, an analysis of covariance was performed for all analyses of standing height data.Results. Of the 100 subjects enrolled, 90 completed the study. The 2 treatment groups were generally comparable at baseline; however, at baseline, mean age and mean height were significantly greater in the BDP treatment group that the in placebo treatment group. In both analyses, overall growth rate was significantly slower in BDP-treated subjects than placebo-treated subjects. The mean change in standing height after 1 year was 5.0 cm in the BDP-treated subjects compared with 5.9 cm in the placebo-treated subjects. The difference in growth rates was evident as early as the 1-month treatment visit, suggesting that the effect on growth occurred initially.The growth-suppressive effect of BDP remained consistent across all age and gender subgroups, and among subjects with and without a previous history of corticosteroid use. Use of additional exogenous corticosteroids during the study was similar in both groups and did not affect the results.Because there was a basel...

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Section: Discussionmentioning

confidence: 99%

Detection of Growth Suppression in Children During Treatment With Intranasal Beclomethasone Dipropionate

Rachelefsky²,

et al. 2000

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“…There is convincing evidence that daily maintenance treatment with systemic corticosteroids reduces growth in children with various diseases [1,2]. Alternate-day oral corticosteroid therapy is also associated with reduced growth, but to a lesser degree than a daily schedule [3].…”

Section: What Are the Issues In This Case?mentioning

confidence: 99%

Inhaled corticosteroids reduce growth. Or do they?

Brand

2001

Eur Respir J

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The class label warning in the United States for inhaled corticosteroids (ICS's) states that these drugs may reduce growth velocity in children. In this paper, the evidence for this warning is reviewed from a clinical point of view.Children with asthma tend to grow slower than their healthy peers during the prepubertal years because they go into puberty at a later age. However, asthmatic children do achieve a (near) normal adult height. In randomized controlled clinical trials, the use of inhaled beclomethasone, budesonide and fluticasone is associated with a reduced growth during the first months of therapy, in the order of magnitude of approximately 0.5–1.5 cm·yr−1. It is, however, unlikely that such an effect continues or persists because accumulating evidence shows that asthmatic children, even when they have been treated with ICS for years, attain normal adult height. Individual rare cases have been reported, however, where ICS use was associated with clinically relevant growth suppression.Inhaled corticosteroids are the most effective therapy available for maintenance treatment of childhood asthma. Fear of reduced growth velocity is based on exceptional cases and not on group data. It should, therefore, not be a reason to withhold or withdraw such highly effective treatment in children with asthma.

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“…Age and pubertal stage at withdrawal are important for the final outcome of growth. The risk of permanent stunting can be reduced if the treatment is withdrawn before the pubertal growth spurt occurs, although reduction of final height has been seen after several years of treatment with low daily doses of prednisolone [9]. …”

Section: Systemic Corticosteroids and Final Heightmentioning

confidence: 99%

Growth Problems in Children with Asthma

Wolthers¹

2002

Horm Res Paediatr

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Growth problems are often seen in children with asthma. Rarely, these problems may be caused by poor asthma control. Negatively-deviating growth curves in asthmatic boys aged 8–15 years are often associated with a chronic delay in growth and puberty. Daily treatment with any dose of systemic corticosteroids suppresses the growth rate for as long as the treatment is maintained. The risk of growth rate suppression due to inhaled corticosteroids depends on the dose, administration regimen and delivery device. The risk becomes significant with ≧800 µg budesonide from a metered-dose inhaler with a spacer, and with ≧400 µg budesonide or fluticasone propionate from a dry-powder inhaler. Regardless of the treatment modality applied, all children with asthma should have their height growth measured at least every 6 months, and indications for endocrine work-up should follow general criteria for a growth-insufficient child.

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Long‐term Treatment with Glucocorticoids/ACTH in Asthmatic Children III.

Cited by 37 publications

References 15 publications

Detection of Growth Suppression in Children During Treatment With Intranasal Beclomethasone Dipropionate

Detection of Growth Suppression in Children During Treatment With Intranasal Beclomethasone Dipropionate

Inhaled corticosteroids reduce growth. Or do they?

Growth Problems in Children with Asthma

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