ORIGINAL ARTICLES
Safety of inhaled corticosteroid therapy in young children with asthma

https://doi.org/10.1016/S1081-1206(10)62293-4Get rights and content

Background

Physicians have had some reluctance to use inhaled corticosteroids in very young children with asthma because of the possible risks of adverse systemic effects.

Objective

The purpose of this study was to evaluate the effects of fluticasone propionate on growth and adrenocortical function in young children with asthma.

Methods

We performed an open, prospective study for 24 weeks of 20 children with asthma, 2.5 to 5.0 years of age, who had received fluticasone by a large volume spacer at dosages ranging from 190.50 to 565.40 μg/m2 daily. Growth was evaluated by height standard deviation scores measured by a stadiometer. Adrenocortical function was evaluated twice in each child, before and after the study, by determining fasting serum cortisol concentrations at 8 am and also at 30 and 60 minutes after adrenocorticotropic hormone stimulation. Posttreatment values of height standard deviation scores and fasting morning serum cortisol concentrations were compared with those of 18 age-matched children, who constituted the control group.

Results

The evaluation of mean ± sem (and range) of height standard deviation scores revealed a significant decrease from 0.44 ± 0.27 (−1.46 to 2.22) to 0.28 ± 0.26 (−1.51 to 2.07; P = 0.01) at week 18 and to 0.25 ± 0.24 (−1.90 to 2.13; P = 0.04) at the week 24 in fluticasone-treated children. At the end of the treatment, however, height standard deviation scores of these children did not differ significantly (P = 0.35) from those of the control group. Delayed growth with medium-duration treatment was not associated with alterations in serum cortisol measurements, either at baseline or after stimulation. The mean fasting morning serum cortisol concentrations did not differ significantly between the fluticasone-treated patients and the control group.

Conclusions

Some concern prevails about the safety of medium- or long-term treatment with regularly inhaled corticosteroids in young children with asthma. The prepubertal growth may be delayed, but the effect on ultimate height remains uncertain in such children. Growth should be regularly monitored in children who begin inhaled corticosteroid therapy for mild persistent asthma at an age <5 years old.

REFERENCES (26)

  • IF Price et al.

    Growth during one year of treatment with fluticasone propionate or sodium cromoglycate in children with asthma

    Pediatr Pulmonol

    (1997)
  • I Turktas et al.

    An open study to assess the safety and efficacy of fluticasone propionate in preschool asthmatic children

    Allergy

    (1998)
  • O Neyzi

    Büyüme ve gelisme bozukluklan

  • Cited by (13)

    • Maternal positive skin prick test results and asthma prediction after early childhood wheezing

      2007, Annals of Allergy, Asthma and Immunology
      Citation Excerpt :

      For children who develop asthma in infancy, early intervention may still be beneficial. Treating all wheezing infants with a medicine regularly may expose them to a variety of adverse effects and carry a tremendous burden, both psychological and financial.3-8 Therefore, it would be desirable to establish criteria to distinguish the subgroup of infants with wheezing who will develop asthma later in life.

    • Fluticasone propionate nasal spray is superior to montelukast for allergic rhinitis while neither affects overall asthma control

      2005, Chest
      Citation Excerpt :

      Perhaps more importantly, 24-h urinary cortisol excretion concentrations at baseline (ie, at a time when > 68% of patients across the groups were not receiving an ICS) and after 4 weeks of treatment with either FPANS plus FSC, montelukast plus FSC, or placebo plus FSC were comparable, and there was no evidence of a differential effect among the three treatment groups. The lack of effect of fluticasone propionate on hypothalamic-pituitary-adrenal axis function in this study, as assessed by 24-h urinary cortisol excretion, is consistent with previous studies.2526272829 Despite the strong evidence for an immunologically integrated “one airway,” this study suggests that the applicability of this hypothesis to clinical treatment of rhinitis and asthma may be limited.

    View all citing articles on Scopus
    View full text