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Collagen metabolism and growth in prepubertal children with asthma treated with inhaled steroids
S Crowley1, P Trivedi, L Risteli
1Department of Paediatric Endocrinology, The Middlesex Hospital, London, United Kingdom.
Insights
Inhaled steroids in children with asthma reduce collagen synthesis and turnover, impacting growth. Collagen markers better reflect growth disturbances than bone metabolism markers.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Biochemistry
Background:
- Asthma is a common chronic respiratory disease in children.
- Inhaled corticosteroids (ICS) are the mainstay of asthma treatment.
- Potential effects of long-term ICS use on growth and bone metabolism in children require investigation.
Purpose of the Study:
- To investigate growth and markers of collagen and bone metabolism in prepubertal children with asthma.
- To compare these markers between children treated with inhaled steroids and controls.
Main Methods:
- Prospective study measuring growth velocity over 12 months in 56 prepubertal children with asthma.
- Assessed markers of collagen types I and III synthesis (PINP, PICP, PIIINP) and type I degradation (ICTP).
- Measured bone metabolism markers: bone-specific alkaline phosphatase and osteocalcin.
Main Results:
- Children on inhaled steroids showed reduced collagen synthesis (PINP, PIIINP) and degradation (ICTP) compared to controls.
- Serum osteocalcin was significantly reduced in children treated with inhaled steroids.
- A significant correlation was observed between collagen markers (PIIINP, ICTP) and growth velocity.
Conclusions:
- Long-term inhaled steroid treatment in children with asthma is associated with reduced collagen turnover.
- Collagen synthesis markers (PINP, PIIINP) are more sensitive indicators of growth disturbance than bone-specific alkaline phosphatase and osteocalcin.
Objective:
To investigate growth and markers of collagen and bone metabolism in prepubertal children with asthma.
Study Design:
We measured growth velocity over 12 months and markers of collagen types I and III synthesis (PINP, PICP, PIIINP), collagen type I degradation (ICTP), and bone metabolism (bone-specific alkaline phosphatase and osteocalcin) on one occasion in 56 prepubertal children with stable asthma, 39 of whom were treated with inhaled budesonide or beclomethasone. Collagen data were compared with normal control values.
Results:
Children treated with inhaled steroids had reduced collagen synthesis (PINP, PIIINP) compared with control subjects (p = 0.038, p = 0.045), although PICP was increased (p = 0.05). Carboxyterminal telopeptide of type I collagen was reduced in patients treated with inhaled steroids (p < 0.0005) compared with nonsteroid-treated patients. Serum osteocalcin but not bone-specific alkaline phosphatase was significantly reduced in children treated with inhaled steroids (p < 0.02). Significant correlation was observed between PIIINP and ICTP and growth velocity.
Conclusion:
Collagen turnover is reduced in children with asthma receiving long-term inhaled steroid treatment. Markers of collagen synthesis provide a more accurate reflection of growth disturbance than osteocalcin and bone-specific alkaline phosphatase.