Substantially reduced calcaneal bone ultrasound parameters in severe untreated asthma

We report the case of a 9-year-old male patient with severe bronchial asthma, who had not received inhaled corticosteroids (ICS) despite persistent asthma symptoms and 2 life-threatening asthma attacks. ICS application had been avoided for fear of systemic side effects like bone density loss. Quantitative ultrasound (QUS) is a noninvasive and ionizing radiation-free method to assess bone characteristics. In our clinic, regional age-, sex-, weight- and height-related references for calcaneal QUS were generated from 3,299 children and adolescents. Ultrasonic bone parameters from our patient were substantially reduced at the initial measurement when the patient was 6 years of age by up to -3.75 standard deviation scores. At the same time, chronic pulmonary hyperinflation led to severe thoracic deformation. Only when a second life-threatening asthma attack almost required mechanical ventilation, the family was convinced to have ICS therapy initiated. This treatment led to clinical stabilization including normalization of the thoracic shape. In parallel, QUS values improved continuously up to the normal range. Our case report emphasizes the risks of omitting ICS in severe asthma for fear for systemic side effects. On the contrary, ICS in low to medium dosages may allow regular growth, bone development and normalization of previously severe effects of the disease itself.