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| |  ESPE: Leg Bone Growth Rate Slower In Asthmatic Children Using Budesonide By Cameron Johnston Special to DG News
MONTREAL, QC -- July 12, 2001 -- Pre-pubertal children who are treated with budesonide (200 mcg bid) for asthma have a significantly reduced one-year growth rate as compared with healthy controls. This finding was presented yesterday at the 6th joint meeting of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology (ESPE) in collaboration with the Australasian Paediatric Endocrine Group, the Japanese Society for Pediatric Endocrinology, and the Latin American Society for Paediatric Endocrinology held in Montreal, Quebec, Canada. The study confirms what has been shown in other research -- namely that inhaled corticosteroids do have an impact on bone growth and development and that this change is significant over a short period of time. However, lead investigator Dr. Carsten Heuck of the department of pediatrics at Aarhus University Hospital, in Risskov, Denmark, said the study was in no way meant to infer what the impact of budesonide-use would be on the child's final adult height. Nor, he said, was this research meant to compare inhaled steroids with oral steroids. In the study, 15 children with asthma, mean age 9.2 years, were treated with budesonide inhaled dry powder (Turbuhaler) and were compared with 17 healthy controls. The children were measured for height, but more specifically, for the speed of growth in the lower leg length -- a process known as knemometry, which looks only at the change in length of the tibia and fibula. Knemometry examines only at these bones because childhood growth of the tibia and fibula is steady and more or less constant, whereas growth of other bones, such as the femur or the bones in the arm, occurs in spurts and is less predictable. The children in this study were examined at two, four, eight and 12-week intervals. Lower leg growth was shorter in the budesonide group in every case. Children using budesonide experienced less growth of the lower leg at all phases of the study -- particularly in the first two weeks, when the difference was 27 mm/week of growth compared with 56 mm/week in the healthy control group (p=0.01). Overall growth in total height at the end of the year was also less in the budesonide group: 4.8 cm versus 6.8 in the control group (p=0.002). Dr. Heuck said the short-term decrease in lower leg length seems to translate into a reduced growth rate that has been seen in population-based studies of asthmatics, who were treated over the longer term with inhaled steroids. Nonetheless, caution must be used in extrapolating these findings to suggest that the use of budesonide will affect one's adult height, he said, because children can still experience profound growth spurts during puberty that could make up for any short-fall in growth rates seen in this study.
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