Skip to main content
The BMJ logoLink to The BMJ
. 1991 Jul 20;303(6795):163–165. doi: 10.1136/bmj.303.6795.163

Growth of asthmatic children during treatment with budesonide: a double blind trial.

O D Wolthers 1, S Pedersen 1
PMCID: PMC1670402  PMID: 1878641

Abstract

OBJECTIVE--To determine whether the inhaled glucocorticosteroid budesonide has any adverse effect on short term linear growth in children with mild asthma. SETTING--Outpatient clinic in secondary referral centre. PATIENTS--15 children aged 6-13 years with normal statural growth velocity during the previous year, no signs of puberty, and no use of systemic or topical steroids in the two months before the study. DESIGN OF INTERVENTIONS--Double blind, randomised crossover trial with two active periods in which budesonide was given in divided daily doses of 200 micrograms and 800 micrograms. During run in and two washout periods placebo was given. After the second washout period the children received open treatment with 400 micrograms budesonide daily. All periods were of 18 days' duration. MAIN OUTCOME MEASURE--Growth of the lower leg as measured twice a week by knemometry. RESULTS--Mean growth velocity of the lower leg was 0.63 mm/week during run in and during washout 0.64 mm/week. Budesonide treatment was associated with a significant dose related reduction of growth velocity: the mean reduction in growth velocity during treatment was 0.11 (95% confidence interval -0.15 0.36 (0.13 to 0.59) mm/week with 800 micrograms budesonide (p less than 0.05; Page's test). During treatment with 400 micrograms budesonide a reduction of 0.17 (-0.10 to 0.45) mm/week was found. CONCLUSIONS--Treatment with inhaled budesonide is associated with a dose related suppression of short term linear growth in children with mild asthma.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balfour-Lynn L. Growth and childhood asthma. Arch Dis Child. 1986 Nov;61(11):1049–1055. doi: 10.1136/adc.61.11.1049. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. FALLIERS C. J., SZENTIVANYI J., McBRIDE M., BUKANTZ S. C. Growth rate of children with intractable asthma. Observations on the influence of the illness and its therapy with steroids. J Allergy. 1961 Sep-Oct;32:420–434. doi: 10.1016/0021-8707(61)90020-x. [DOI] [PubMed] [Google Scholar]
  3. Francis R. S. Long-term beclomethasone dipropionate aerosol therapy in juvenile asthma. Thorax. 1976 Jun;31(3):309–314. doi: 10.1136/thx.31.3.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Friedman M., Strang L. B. The effects of corticosteroid and ACTH therapy on growth and on the hypothalamic-pituitary adrenal axis of children. Scand J Respir Dis Suppl. 1969;68:58–69. [PubMed] [Google Scholar]
  5. Godfrey S., Balfour-Lynn L., Tooley M. A three- to five-year follow-up of the use of the aerosol steroid, beclomethasone dipropionate, in childhood asthma. J Allergy Clin Immunol. 1978 Dec;62(6):335–339. doi: 10.1016/0091-6749(78)90133-1. [DOI] [PubMed] [Google Scholar]
  6. Godfrey S., König P. Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol. Arch Dis Child. 1974 Aug;49(8):591–596. doi: 10.1136/adc.49.8.591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goldstein D. E., König P. Effect of inhaled beclomethasone dipropionate on hypothalamic-pituitary-adrenal axis function in children with asthma. Pediatrics. 1983 Jul;72(1):60–64. [PubMed] [Google Scholar]
  8. Graff-Lonnevig V., Kraepelien S. Long-term treatment with beclomethasone dipropionate aerosol in asthmatic children with special reference to growth. Allergy. 1979 Feb;34(1):57–61. doi: 10.1111/j.1398-9995.1979.tb02001.x. [DOI] [PubMed] [Google Scholar]
  9. Hauspie R., Susanne C., Alexander F. Maturational delay and temporal growth retardation in asthmatic boys. J Allergy Clin Immunol. 1977 Mar;59(3):200–206. doi: 10.1016/0091-6749(77)90150-6. [DOI] [PubMed] [Google Scholar]
  10. Hermanussen M., Geiger-Benoit K., Burmeister J., Sippell W. G. Knemometry in childhood: accuracy and standardization of a new technique of lower leg length measurement. Ann Hum Biol. 1988 Jan-Feb;15(1):1–15. doi: 10.1080/03014468800009411. [DOI] [PubMed] [Google Scholar]
  11. Hermanussen M., Geiger-Benoit K., Burmeister J., Sippell W. G. Periodical changes of short term growth velocity ('mini growth spurts') in human growth. Ann Hum Biol. 1988 Mar-Apr;15(2):103–109. doi: 10.1080/03014468800009521. [DOI] [PubMed] [Google Scholar]
  12. Hills M., Armitage P. The two-period cross-over clinical trial. Br J Clin Pharmacol. 1979 Jul;8(1):7–20. doi: 10.1111/j.1365-2125.1979.tb05903.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hughes I. A. Steroids and growth. Br Med J (Clin Res Ed) 1987 Sep 19;295(6600):683–684. doi: 10.1136/bmj.295.6600.683-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kerrebijn K. F. Beclomethasone dipropionate in long-term treatment of asthma in children. J Pediatr. 1976 Nov;89(5):821–826. doi: 10.1016/s0022-3476(76)80816-5. [DOI] [PubMed] [Google Scholar]
  15. Kerrebijn K. F., de Kroon J. P. Effect of height of corticosteroid therapy in asthmatic children. Arch Dis Child. 1968 Oct;43(231):556–561. doi: 10.1136/adc.43.231.556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Law C. M., Marchant J. L., Honour J. W., Preece M. A., Warner J. O. Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet. 1986 Apr 26;1(8487):942–944. doi: 10.1016/s0140-6736(86)91045-7. [DOI] [PubMed] [Google Scholar]
  17. Littlewood J. M., Johnson A. W., Edwards P. A., Littlewood A. E. Growth retardation in asthmatic children treated with inhaled beclomethasone dipropionate. Lancet. 1988 Jan 16;1(8577):115–116. doi: 10.1016/s0140-6736(88)90310-8. [DOI] [PubMed] [Google Scholar]
  18. Murray A. B., Fraser B. M., Hardwick D. F., Pirie G. E. Chronic asthma and growth failure in children. Lancet. 1976 Jul 24;2(7978):197–198. doi: 10.1016/s0140-6736(76)92366-7. [DOI] [PubMed] [Google Scholar]
  19. Nassif E., Weinberger M., Sherman B., Brown K. Extrapulmonary effects of maintenance corticosteroid therapy with alternate-day prednisone and inhaled beclomethasone in children with chronic asthma. J Allergy Clin Immunol. 1987 Oct;80(4):518–529. doi: 10.1016/0091-6749(87)90002-9. [DOI] [PubMed] [Google Scholar]
  20. Pedersen S., Fuglsang G. Urine cortisol excretion in children treated with high doses of inhaled corticosteroids: a comparison of budesonide and beclomethasone. Eur Respir J. 1988 May;1(5):433–435. [PubMed] [Google Scholar]
  21. Stead R. J., Cooke N. J. Adverse effects of inhaled corticosteroids. BMJ. 1989 Feb 18;298(6671):403–404. doi: 10.1136/bmj.298.6671.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. The choice of vascular prostheses. Lancet. 1980 Jan 12;1(8159):76–77. [PubMed] [Google Scholar]
  23. Valk I. M., Chabloz A. M., Smals A. G., Kloppenborg P. W., Cassorla F. G., Schutte E. A. Accurate measurements of the lower leg length and the ulnar length and its application in short term growth measurement. Growth. 1983 Spring;47(1):53–66. [PubMed] [Google Scholar]
  24. Vaz R., Senior B., Morris M., Binkiewicz A. Adrenal effects of beclomethasone inhalation therapy in asthmatic children. J Pediatr. 1982 Apr;100(4):660–662. doi: 10.1016/s0022-3476(82)80781-6. [DOI] [PubMed] [Google Scholar]
  25. Wales J. K., Milner R. D. Knemometry as a predictor of response to somatrem in Turner's syndrome. Acta Paediatr Scand Suppl. 1987;337:37–39. doi: 10.1111/j.1651-2227.1987.tb17125.x. [DOI] [PubMed] [Google Scholar]
  26. Wales J. K., Milner R. D. Knemometry in assessment of linear growth. Arch Dis Child. 1987 Feb;62(2):166–171. doi: 10.1136/adc.62.2.166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Williams H., Read G. F., Verrier-Jones E. R., Hughes I. A. Effect of inhaled beclomethasone dipropionate on saliva cortisol concentrations. Arch Dis Child. 1984 Jun;59(6):553–556. doi: 10.1136/adc.59.6.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wit J. M., van Kalsbeek E. J., van Wijk-Hoek J. M., Leppink G. J. Assessment of the usefulness of weekly knemometric measurements in growth studies. Acta Paediatr Scand. 1987 Nov;76(6):974–980. doi: 10.1111/j.1651-2227.1987.tb17274.x. [DOI] [PubMed] [Google Scholar]
  29. Wolthers O. D., Pedersen S. Growth of asthmatic children during treatment with budesonide: a double blind trial. BMJ. 1991 Jul 20;303(6795):163–165. doi: 10.1136/bmj.303.6795.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wolthers O. D., Pedersen S. Short term linear growth in asthmatic children during treatment with prednisolone. BMJ. 1990 Jul 21;301(6744):145–148. doi: 10.1136/bmj.301.6744.145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wyatt R., Waschek J., Weinberger M., Sherman B. Effects of inhaled beclomethasone dipropionate and alternate-day prednisone on pituitary-adrenal function in children with chronic asthma. N Engl J Med. 1978 Dec 21;299(25):1387–1392. doi: 10.1056/NEJM197812212992504. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES