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Am Fam Physician. 1998;57(11):2819

Anti-inflammatory medicines such as inhaled corticosteroids have been shown to be effective in treating asthma. Nevertheless, many physicians hesitate to prescribe inhaled corticosteroids for children because of possible adverse effects on bone growth and formation. Agertoft and Pedersen evaluated the long-term effects of inhaled budesonide on total-body bone mineral density, total-body bone mineral capacity, total-body bone calcium and body composition in children with asthma.

A total of 268 children participated in the controlled, prospective clinical study. The study group included 157 children who were treated with inhaled budesonide at a mean dosage of 504 μg (range: 189 to 1,322 μg) for an average of three to six years. This group was matched by age, weight, height and sex with a control group of 111 children with asthma. Members of the control group had never received inhaled corticosteroids for more than two weeks per year. Exclusion criteria for participation in the study included use of systemic steroids for more than 14 days, use of topical steroids over more than 25 percent of the body (after two years of age) and use of nasal corticosteroids for more than one month per year. The dosage of inhaled steroid in the study group was chosen for a level that controlled clinical symptoms while maintaining the minimum dosage to relieve symptoms. Dual energy photon absorptiometry (DEXA scan) was used to compare the bone mineral density, bone mineral capacity, bone calcium and body composition of children treated with budesonide and children in the control group.

No statistically significant difference was found between the children receiving budesonide and the control subjects with regard to bone mineral density, bone mineral capacity or bone calcium. No correlation was found between these parameters and duration of treatment or cumulative dosage received by the study group.

The authors conclude that treating children with inhaled budesonide for an average of 4.5 years at a mean daily dosage of 504 μg has no detectable effect on the total bone mineral density, total bone mineral capacity, total bone calcium or body composition of children with asthma. The dosage, however, must be tailored to the severity of disease. They caution that this data should not be extrapolated to include other inhaled corticosteroids or higher dosages of budesonide, which may have long-term adverse effects in children.

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Copyright © 1998 by the American Academy of Family Physicians.

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