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Body composition and growth in asthmatic children treated with inhaled steroids
A Salvatoni1, L Nosetti, M Broggini
1Pediatric Department, Faculty of Medicine and Surgery, University of Insubria, Ospedale di Circolo Hospital, Varese, Italy. clipedva@tin.it
Insights
Six months of inhaled steroids (budesonide/fluticasone) did not cause body fat accumulation in children. However, monitoring growth is crucial as some preschool children experienced reduced growth velocity.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
- Asthma Management
Background:
- Inhaled corticosteroids (ICS) are vital for pediatric asthma control.
- Prolonged ICS use may impact children's growth and body composition.
- Assessing the short-term effects of ICS on growth and body fat is important.
Purpose of the Study:
- To determine if 6 months of ICS treatment affects body fat and growth velocity in children.
- To compare the effects of budesonide and fluticasone propionate versus standard asthma care.
Main Methods:
- An open-label study involving 42 asthmatic children.
- Groups received inhaled budesonide (400 mcg/day), fluticasone propionate (200 mcg/day), or no ICS (control).
- Body composition (DXA, BIA, skinfolds) and growth velocity were measured over 6 months.
Main Results:
- No significant differences in fat mass or growth velocity were observed between ICS groups and the control group.
- Average changes in fat mass were similar across all treatment groups.
- Seven children (3 on ICS, 2 in control) showed growth velocity below the third percentile.
Conclusions:
- Six-month treatment with inhaled budesonide or fluticasone propionate does not lead to body fat accumulation.
- A small subset of preschool children may experience reduced growth velocity, necessitating monitoring.
- Further research on ICS effects in preschool asthmatic children is warranted.
Background:
Prolonged treatment with inhaled steroids is recommended for long-term control of asthma in children; however, it can interfere with growth and body composition.
Objective:
The aim of this study is to answer the question whether 6 months treatment with inhaled steroids causes body fat accumulation and growth velocity reduction.
Methods:
Hospital-based, open study of body composition [by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and skinfolds] and growth of 26 asthmatic children, treated for 6 months with inhaled steroids [budesonide (BUD) 400 microg/day (group 1) or fluticasone proprionate (FP) 200 microg/day (group 2)], sodium cromoglycate and beta2-agonist (salbutamol) compared with a control group of 16 asthmatic children treated only with sodium cromoglycate and beta2-agonist.
Results:
On average, total and regional fat mass, adjusted for pubertal stage and gender, and growth velocity were similar in all three groups of patients and were not influenced by treatment (% mean change +/- 1 SD of fat mass during treatment in BUD 0.1 +/- 3.0%, FP -1.1 +/- 3%, and control -2.8 +/- 3.5%; ANOVA P > or = .05); however seven patients, two in group 1 (1 preschool child), three in group 2 (2 preschool children) and two in the control group (two prepubertal boys aged 8.5 and 9.5 year), during treatment, showed a growth velocity standard deviation score below the third percentile.
Conclusion:
A 6-month treatment with inhaled BUD and FP does not induce body fat accumulation; however, in a few preschool children the treatment was associated with growth velocity below the third percentile. Our results suggest the need for constant monitoring of growth in all asthmatic children on chronic treatment with inhaled steroids. Further studies devoted to the effects of inhaled steroids use in preschool children are needed.