Chest
Volume 113, Issue 3, March 1998, Pages 584-586
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Clinical Investigations: Asthma
Short-term Growth in Asthmatic Children Using Fluticasone Propionate

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Background

Inhaled corticosteroids may reduce short-term growth velocity in asthmatic children and knemometry is the most sensitive tool to detect this short-term growth suppression.

Study objective

To compare lower leg growth velocity, as measured by knemometry, in asthmatic children during and after treatment with inhaled fluticasone propionate (FP), 100 μg twice daily.

Design

Nonrandomized open trial.

Setting

University hospital, outpatient clinic for pediatric pulmonology.

Patients

Twenty-one asthmatic children (13 boys), aged 6 to 10 years.

Interventions

Inhalation of FP from a dry powder inhaler, 100 μg, twice daily for 6 weeks, followed by 2 weeks during which only an inhaled β2_agonist was used on demand (washout). During treatment and washout periods, patients were seen every 2 weeks at the same time of day.

Measurements and results

Lower leg growth velocity measured by knemometry during FP treatment was not significantly different from that during washout (p=0.33, one-way analysis of variance).

Conclusions

No significant suppression of lower leg growth velocity was found in prepubertal asthmatic children using FP, 100 pg, by dry powder inhaler twice daily for 6 weeks.

Section snippets

Materials and Methods

The present study was undertaken during the baseline period of an ongoing long-term clinical trial on effects and side effects of two different treatment schedules of FP. The baseline period of this trial consisted of a 6-week run-in period during which patients inhaled FP from a dry-powder inhaler (Diskhalerinhaler; Glaxo Wellcome; Greenford, UK) at a dose of 100 μg twice daily, followed by a 2-week washout period during which patients used no inhaled corticosteroids or other anti-inflammatory

Results

Twenty-one patients completed the study. Clinical characteristics are shown in Table 1. Figure 1 shows the lower leg growth velocity during 6 weeks of treatment with inhaled corticosteroids (run-in phase) and during 2 weeks without inhaled corticosteroids (washout phase). Because there was no difference in left and right lower leg growth velocity, the mean of both legs was used.

Blister counts showed mean (SD) compliance with prescribed dosages of 94% (9%). There were no significant differences

Discussion

In this study, we did not find a (significant) reduction in lower leg growth velocity in asthmatic children during treatment with FP, 100 μg bid, via dry-powder inhaler as compared with treatment with only an inhaled β2-agonist on demand. In fact, the observed trend (Fig 1) was that lower leg growth velocity tended to increase during treatment with FP. Thus, it is highly unlikely that our results can be explained by insufficient power to detect a growthsuppressing effect of FP on short-term

References (10)

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Cited by (32)

  • Effect on growth of long-term treatment with intranasal triamcinolone acetonide aqueous in children with allergic rhinitis

    2008, Annals of Allergy, Asthma and Immunology
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    Although published guidelines recommend primary INS treatment for patients with AR,1,4,5 there remain concerns that this treatment may cause growth suppression in children and adolescents. In that regard, there is a large body of studies18–23 that support growth suppression in some patients treated with inhaled corticosteroids (ICSs) for asthma or INSs for AR, but much of that work focuses on short-term growth effects as measured by means of knemometry. Long-term treatment studies report conflicting results.19,24–31

  • Safety of inhaled corticosteroids: Room for improvement

    2007, Pulmonary Pharmacology and Therapeutics
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    A third double-blind study in 40 children with asthma, ages 1–3 years, indicated that both FP and budesonide caused a significant slowing of lower-leg growth compared with placebo [41]. Although these studies indicate a decrease in growth velocity in the short term and reflect systemic effects of ICS, other studies suggest that ICS have no significant effect on long-term growth [42]. Some surveys have demonstrated no negative effect of ICS on attainment of adult height.

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This study was supported by Glaxo Wellcome, the Netherlands.

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