Assessment of the relation between short and intermediate term growth in children with asthma treated with inhaled glucocorticoids

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Abstract

Objective

To assess the relation between short-term growth and intermediate term growth in children with asthma treated with inhaled glucocorticoids.

Design

An open 12 months parallel group trial with visits to the clinic on day 1, after 2, 4, 8, 12, 20, 28, 36, 44 and 52 weeks. Setting: Outpatient clinic in a secondary referral centre. Subjects: Sixteen children with asthma aged 9 (6–13) years; 16 matched healthy subjects.

Methods

Knemometry and stadiometry. Interventions: Dry-powder inhaled budesonide 200 μg twice daily. Primary outcome measures: Intra-group comparisons of mean lower leg growth rates. Secondary outcome measures: Inter-group comparisons of mean lower leg growth rates and intra-group comparisons of mean height-standard deviation scores.

Results

One year mean lower leg growth rate (0.36 mm/week) did not differ from the rates during the 2 (0.27 mm/week; P = 0.23), 4 (0.33 mm/week; P = 0.54), 8 (0.36 mm/week; P = 0.79) or 12 (0.33 mm/week; P = 0.49) weeks intervals in the asthma group. Similarly, in the healthy children 2 (0.56 mm/week; P = 0.63), 4 (0.46 mm/week; P = 0.36), 8 (0.43 mm/week; P = 0.49) and 12 (0.43 mm/week; P = 0.66) weeks mean growth rates did not vary statistically significantly from the 1 year growth rate (0.42 mm/week). Mean lower leg growth rates, however, were consistently lower during all periods in the children with asthma (P = 0.02–0.03). At completion of the study mean height-standard deviation score in the asthma group (−0.19) was significantly suppressed as compared with the score at study entry (−0.03) (P = 0.02), whereas no statistically significant variation was detected in the control group.

Conclusions

Short-term lower leg growth rates are consistent with intermediate term growth rates in group studies in children with asthma treated with inhaled dry powder budesonide 400 μg/day. Short-term group knemometry should be an integral part of growth evaluations of new inhaled glucocorticoids, doses and inhalation devices in children with asthma.

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