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Growth and pituitary-adrenal function in children with severe asthma treated with inhaled budesonide
1Department of Pediatrics, Hasharon Hospital, Golda Medical Center, Petach-Tiqva, Israel.
Insights
Inhaled budesonide (a corticosteroid) is safe for young children with severe asthma. Long-term use did not affect growth or pituitary-adrenal function, improving asthma symptoms.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
Background:
- Inhaled corticosteroids (ICS) are widely used for pediatric asthma management.
- Concerns exist regarding the long-term safety of ICS in young children.
Purpose of the Study:
- To evaluate the safety of long-term inhaled budesonide administration in young children with severe asthma.
- To assess the impact on growth and pituitary-adrenal function.
Main Methods:
- A study of 15 children (2-7 years) with severe perennial asthma.
- Inhaled budesonide (100 mcg twice daily) administered for 3-5 years.
- Safety assessed via height, weight, bone age, and pituitary-adrenal function tests.
Main Results:
- Significant asthma symptom reduction (58% fewer symptom days) and bronchodilator use (75% decrease) within one month.
- Normal growth patterns (height, weight, bone age) observed throughout treatment.
- No adverse effects on pituitary-adrenal function, evidenced by normal cortisol levels and urinary excretion.
Conclusions:
- Daily inhaled budesonide at 200 mcg is safe for young children with severe asthma.
- Prolonged treatment does not impair growth or pituitary-adrenal function.
Background:
The increased use of inhaled corticosteroids in the management of asthma raises concern about the safety of these drugs in children. We sought to determine the safety of long-term administration of inhaled budesonide in young children with asthma.
Methods:
We studied 15 children 2 to 7 years old who had severe perennial asthma. They inhaled 100 micrograms of budesonide twice daily for three to five years. Efficacy was assessed by serial evaluation of respiratory symptoms and the need for other medications, and safety by serial evaluation of height, height velocity, weight, bone age, and pituitary-adrenal function.
Results:
The severity of asthma decreased within the first month after the initiation of therapy, as demonstrated by a 58 percent reduction in the number of days with symptoms of asthma and a 75 percent decrease in the use of bronchodilators. This improvement was maintained thereafter. The growth pattern of all patients, including their height, weight, and bone age, was normal (as compared with standard normal values) throughout the treatment period. Pituitary-adrenal function was not adversely affected by the treatment, as demonstrated by normal serum cortisol concentrations in the morning and 60 minutes after stimulation with corticotropin, normal 24-hour serum cortisol concentrations (mean [+/- SD] of samples collected at 30-minute intervals for 24 hours, 8.4 +/- 4.2 micrograms per deciliter [232 +/- 116 nmol per liter]), and normal urinary cortisol excretion (34 +/- 9 micrograms [95 +/- 25 nmol] per day).
Conclusions:
Prolonged administration of 200 micrograms of inhaled budesonide daily to young children with severe asthma does not impair growth or pituitary-adrenal function.