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Safety of inhaled corticosteroid therapy in young children with asthma
I Turktas1, O Ozkaya, I Bostanci
1Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey. ipekt@med.gazi.edu.tr
Insights
Inhaled corticosteroids like fluticasone propionate may temporarily slow growth in young children with asthma. However, this study found no long-term impact on height or adrenal function, suggesting regular monitoring is key for early treatment.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
Background:
- Physicians express caution regarding inhaled corticosteroid (ICS) use in pre-pubertal children due to potential systemic adverse effects.
- Asthma management in young children necessitates balancing treatment efficacy with safety concerns.
Purpose of the Study:
- To assess the impact of fluticasone propionate on growth and adrenocortical function in children aged 2.5 to 5.0 years with asthma.
- To address physician reluctance by providing data on the safety profile of ICS in early childhood asthma.
Main Methods:
- An open, prospective study involving 20 children with asthma treated with fluticasone propionate for 24 weeks.
- Growth was monitored using height standard deviation scores, and adrenocortical function was assessed via serum cortisol levels before and after adrenocorticotropic hormone stimulation.
- Comparison was made with a control group of 18 age-matched children.
Main Results:
- A statistically significant, though modest, decrease in height standard deviation scores was observed during the 24-week treatment period (P=0.04).
- At study conclusion, height standard deviation scores did not significantly differ from the control group (P=0.35).
- No significant alterations in baseline or stimulated serum cortisol levels were detected, indicating preserved adrenocortical function.
Conclusions:
- While short-term inhaled corticosteroid treatment may lead to temporary growth deceleration in young children with asthma, the effect on final adult height remains uncertain.
- Regular growth monitoring is recommended for children under 5 years initiating inhaled corticosteroid therapy for mild persistent asthma.
- The study suggests that fluticasone propionate, when used appropriately, does not appear to compromise adrenocortical function in this age group.
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 microg/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.
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