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Am Fam Physician. 2002;65(8):1655-1657

Current studies have shown that some inhaled corticosteroids may have an adverse effect on growth velocities in children. One such agent, fluticasone propionate, has been demonstrated to have minimal impact on growth velocities in children over a 12-month period. De Benedictis and colleagues compared the influence of fluticasone propionate with that of beclomethasone dipropionate in children with a history of chronic asthma.

The study was a prospective, multicenter, randomized, double-blind, parallel-group trial. Inclusion criteria required use of an inhaled corticosteroid and a sexual maturity rating of Tanner stage I. After a two-week run-in period, participants were randomly assigned to receive fluticasone propionate or beclomethasone dipropionate in a dosage of 200 mcg administered by dry-powder inhaler twice daily for 52 weeks. Outcome measures included growth velocities measured by means of stadiometry during the 52-week treatment period, lung function measurements, asthma symptom scores, beta-agonist use, and asthma exacerbation rate.

The adjusted mean growth velocity was significantly higher in the fluticasone group than in the beclomethasone group. The average difference was approximately 1 cm of growth. Both inhaled corticosteroids improved lung function, but the fluticasone group had significantly better improvement of lung functions compared with the beclomethasone group. Adverse events were similar between the two groups. There were no significant differences in the effect of both medications on serum and urinary cortisol levels.

The authors conclude that because of the more favorable risk-benefit ratio, fluticasone is the preferred inhaled corticosteroid in long-term treatment of children with asthma. Fluticasone had less effect on growth velocity and performed better with regard to lung function than beclomethasone. The authors note that the choice of fluticasone is especially important in children who require moderate doses of inhaled steroids to control their asthma.

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