Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol

Godfrey, Simon; König, Peter

doi:10.1136/adc.49.8.591

Cited by 87 publications

(19 citation statements)

References 14 publications

(17 reference statements)

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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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“…Several authors who evaluated asthma patients of different age groups, using different inhaled corticosteroids, and various ways of administration, did not observe a negative impact of these drugs on growth (23,(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74) . In Brazil, Kovalhuk et al (59) did not observe growth retardation either, during the study period, in patients on prednisone given on alternate days or BDP.…”

Section: Inhaled Corticosteroids and Growthmentioning

confidence: 98%

Linear growth in asthmatic children

et al. 2003

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Asthma is the most frequent chronic inflammatory disease in childhood, and its prevalence has increased remarkably over the last decades. Therefore, the scientific community became interested in studying the growth of the affected children. The relationship between asthma and growth suffers the influence of the clinical picture, of therapeutics, but the different study methods make it difficult to distinguish the factors responsible for the growth retardation detected by some authors. This review has the purpose of providing an overall outlook on this matter. (J Pneumol 2003;29(1):36-42)

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“…The advent of inhaled corticosteroids in 1973 [13] led to the hope of disease control without side effects. Compared with oral corticosteroids, inhaled corticosteroids caused dramatically fewer side effects, specifically appearing not to impair growth [14,15] and possibly resulting in improved growth [16].…”

Section: Historical Backgroundmentioning

confidence: 99%

Effects of inhaled corticosteroids on growth in asthmatic children

Creese

Doull

2001

Curr Allergy Asthma Rep

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This article presents a brief review of the effects of inhaled corticosteroids on growth in children with asthma. All currently available inhaled corticosteroids, where there is adequate data, have been shown to cause significant growth suppression in children in a dose-dependent manner. It is now apparent that there are differences in the growth-suppressive effects of different corticosteroids. Recent evidence confirms that the growth-suppressive effects are short lived and that, at conventional doses, inhaled corticosteroids do not affect final attained adult height.

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Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol

Cited by 87 publications

References 14 publications

Effect of inhaled corticosteroids on bones and growth

Effect of inhaled corticosteroids on bones and growth

Linear growth in asthmatic children

Effects of inhaled corticosteroids on growth in asthmatic children

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