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Systemic activity of inhaled topical steroid in toddlers studied by knemometry
1Department of Paediatrics, Rigshospitalet, State University Hospital of Copenhagen, Denmark.
Insights
High-dose inhaled budesonide significantly suppressed lower leg growth rate in toddlers with recurrent wheezing. Low-dose budesonide showed no significant impact on growth, indicating a dose-dependent effect.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Growth and Development
Background:
- Recurrent wheezing is common in toddlers.
- Inhaled corticosteroids are frequently used to manage this condition.
- Potential effects of these medications on linear growth require careful evaluation.
Purpose of the Study:
- To assess the impact of inhaled budesonide on short-term linear growth rate in toddlers with mild recurrent wheezing.
- To compare the effects of low-dose (200 mcg) and high-dose (800 mcg) budesonide against a placebo.
Main Methods:
- Weekly measurement of lower leg linear growth rate using a hand-held knemometer.
- Randomized, double-blind, placebo-controlled crossover study.
- Eighteen toddlers (13-36 months) received placebo, 200 mcg, or 800 mcg budesonide daily for four-week periods.
Main Results:
- The mean growth rates were 92 mcg/day (placebo), 114 mcg/day (low-dose), and 46 mcg/day (high-dose).
- High-dose budesonide significantly suppressed growth rate compared to placebo (95% CI -76 to -17 mcg/day).
- Low-dose budesonide did not significantly differ from placebo (95% CI -7 to +52 mcg/day).
Conclusions:
- Knemometry is a precise and gentle method for measuring short-term linear growth in toddlers.
- High-dose inhaled budesonide can suppress linear growth in this population.
- Low-dose budesonide appears to have a negligible effect on short-term linear growth.
Abstract:
The short-term linear growth rate of the lower leg in toddlers was measured and evaluated in order to study the possible effect of inhaled budesonide on this factor in toddlers with mild recurrent wheezing. The short-term linear growth rate of the lower leg was measured weekly using a hand-held knemometer. Eighteen toddlers aged 13-36 months (mean 27 months) with a history of recurrent wheezing requiring inhaled topical steroids, but without need of regular medication during the months prior to the study, were studied. The children were randomized blindly through three consecutive treatment periods of four weeks with placebo or budesonide in daily doses of 200 micrograms and 800 micrograms administered as a pressurized aerosol inhaled via a spacer with a face mask. Twenty-nine percent (median) of the nominal dose was delivered at the mouth of the children. Three children were withdrawn because of exacerbations and one because of non-compliance. The precision of the measurement procedure was 51 microns/day. The mean growth rate during placebo, low-dose and high-dose steroid treatment was 92 microns/day, 114 microns/day and 46 microns/day respectively. The growth rate during the high-dose treatment was suppressed significantly compared to placebo treatment (95% CI -76 microns/day to -17 microns/day), whereas the growth rate during low-dose steroid treatment was indistinguishable from placebo treatment (95% CI -7 to +52 microns/day). In conclusion, measurement of short-term linear growth rate by knemometry in toddlers is a fast and gentle method with a high level of precision.(ABSTRACT TRUNCATED AT 250 WORDS)