Efficacy and safety of high-dose inhaled steroids in children with asthma: A comparison of fluticasone propionate with budesonide☆,☆☆
Section snippets
METHODS
A cohort of 442 children, ages 4 to 12 years, with a history of moderate to severe asthma were recruited from 6 countries. All had a Sexual Maturity Rating of 1 (prepubertal) at the time of the initial clinic visit. Children with only seasonal or exercise-induced symptoms were excluded. All subjects required moderate to high doses of ICS to control symptoms, 400 to 800 μg of BDP or BUD or 200 to 400 μg of FP per day for at least 1 month preceding the start of the run-in period. All were using
RESULTS
A total of 442 children were enrolled in the study, of whom 333 proceeded to randomized treatment and qualified for the primary population of analysis, the intent-to-treat population. There were 166 subjects who received FP, 200 μg twice daily, and 167 subjects who received BUD, 400 μg twice daily. Twenty-five subjects (7.5%) were ultimately excluded from analysis because of protocol violations (15 receiving FP and 10 receiving BUD); protocol violations were incorrect dose of ICS or inadequate
DISCUSSION
The results of our study are consistent with previous reports of similar clinical efficacy when comparing FP (200 μg) and BDP (400 μg) per day in children with mild to moderate asthma2, 3 and when comparing FP at half the daily dose with BUD in adult asthmatic subjects.4, 5, 6, 7 A study in children with mild to moderate asthma, in which FP and BUD (both 400 μg/d) were compared, showed a similar effect in control of asthma symptoms.8 Our findings of equivalence or superior clinical effect with
Acknowledgements
The following physicians kindly allowed their patients to participate in this study. Canada: B. Lyttle, P. Patel, S. Mehra, P. Zuberbuhler, D. Hughes, B. Muram, D. Hummel, L. Charette, J. Bouchard, D. Wong, W. Arkinstall, and T. Kovesi. Denmark: K. Ibsen and J. Henricksen. Finland: A. Koivikki. Netherlands: J. Pilon, J. Hoekx, W. den Ouden, R. Roorda, and J. Gosen. Indonesia: N. Rahayoe. Poland: J. Pietrzyk, A. Emeryk, and T. Malaczynska. South Africa: G. Brereton-Stiles, M. Ossip, M. Laher,
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Cited by (106)
Question 2: What are the effects of inhaled corticosteroids on growth in children?
2018, Paediatric Respiratory ReviewsCitation Excerpt :A small (0.20 cm/year) but statistically significant difference in linear growth was observed over 12 months, with a lower growth velocity in the higher ICS dose group. A limited number of head-to-head trials compared the effects of ICS on growth between different molecules (beclomethasone vs. fluticasone, budesonide vs. fluticasone, and budesonide vs. ciclesonide) [4,20–24]. These trials have confirmed the findings from the Cochrane review, that first-generation drugs have a slightly larger suppressive effect on growth than newer drugs.
Lung function, airway remodeling, and inflammation in infants: Outcome at 8 years
2015, Annals of Allergy, Asthma and ImmunologyInhaled corticosteroids in children: Effects on bone mineral density and growth
2014, The Lancet Respiratory MedicineEvaluation of adrenocortical function in 3-7 aged asthmatic children treated with moderate doses of fluticasone propionate: Reliability of dehydroepiandrosterone sulphate (dhea-s) as a screening test
2011, Allergologia et ImmunopathologiaCitation Excerpt :A morning cortisol level may be practical to assess the adrenal functions. However, it has been shown to be an insensitive measure of adrenal function in different studies.24,34 In conclusion, fluticasone propionate is unlikely to cause adrenal supression at moderate doses (<400 μg/m2/day), and conventional doses of inhaled corticosteroids in preadrenarchal children may suppress DHEA-S production.
The effects of corticosteroids on bone growth and bone density
2009, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :A more pronounced reduction in growth was seen in younger children and in children with pretreatment lower relative heights.20 Although most studies17–20 documented slowing of growth in the early stages of long-term inhaled corticosteroid use, the good news is that no matter what the inhaled corticosteroid study reveals, children will attain their anticipated height as adults.21 In children, lumbar bone mineral density (BMD) scores adjusted for age- and sex-specific variations (z score) revealed that females were more likely to have osteopenia than males (mean [SD], −1.06 [0.13] and −0.78 [0.16], respectively).
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Reprint requests: Alexander C. Ferguson, MD, University of British Columbia, B.C. Children’s Hospital, 4480 Oak St, Vancouver, BC, V6H 3V4, Canada.
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