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Assessment of the relation between short and intermediate term growth in children with asthma treated with inhaled
1Children's Clinic Randers, Randers, Denmark.
Insights
Short-term growth rates in children with asthma using inhaled glucocorticoids align with longer-term growth. This suggests short-term knemometry is valuable for evaluating new asthma medications and devices in children.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Asthma management in children often involves inhaled glucocorticoids (IGCs).
- Assessing the impact of IGCs on growth is crucial for long-term pediatric health.
- Understanding the relationship between short-term and intermediate-term growth is key to predicting final height outcomes.
Purpose of the Study:
- To evaluate the correlation between short-term and intermediate-term lower leg growth rates in pediatric asthma patients receiving inhaled glucocorticoids.
- To determine if short-term growth assessments accurately reflect longer-term growth patterns in this population.
Main Methods:
- A 12-month open-label parallel group trial involving 16 children with asthma and 16 matched healthy controls.
- Participants received 200 mcg of budesonide twice daily via dry powder inhaler.
- Lower leg growth was measured using knemometry, and overall height was assessed via stadiometry at regular intervals.
Main Results:
- In children with asthma, short-term lower leg growth rates (2-12 weeks) were consistent with the overall 1-year growth rate.
- However, mean lower leg growth rates were consistently lower in the asthma group compared to healthy controls throughout the study.
- Children with asthma showed a statistically significant decrease in mean height-standard deviation score from study entry to completion.
Conclusions:
- Short-term growth measurements using knemometry reliably predict intermediate-term growth in children with asthma treated with inhaled budesonide.
- Knemometry is a valuable tool for the growth evaluation of new inhaled glucocorticoids, dosages, and delivery devices in pediatric asthma patients.
- While short-term growth patterns are consistent, inhaled glucocorticoids may still impact overall height in children with asthma.
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 microg 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 microg/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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