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Systemic activity of inhaled topical steroid in toddlers studied by knemometry
Author(s) -
Bisgaard Hans
Publication year - 1993
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1993.tb12814.x
Subject(s) - medicine , budesonide , placebo , corticosteroid , anesthesia , linear growth , pediatrics , inhalation , alternative medicine , mathematics , pathology
The short‐term linear growth rate of the lower leg in toddlers was measured and evaluated in order to study the possible effect of inhaled budesonide on this factor in toddlers with mild recurrent wheezing. The short‐term linear growth rate of the lower leg was measured weekly using a hand‐held knemonieter. Eighteen toddlers aged 13–36 months (mean 27 months) with a history of recurrent wheezing requiring inhaled topical steroids, but without need of regular medication during the months prior to the study, were studied. The children were randomized blindly through three consecutive treatment periods of four weeks with placebo or budesonide in daily doses of 200 μg and 800 μ g administered as a pressurized aerosol inhaled via a spacer with a face mask. Twenty‐nine percent (median) of the nominal dose was delivered at the mouth of the children. Three children were withdrawn because of exacerbations and one because of non‐compliance. The precision of the measurement procedure was 51 μm/day. The mean growth rate during placebo, low‐dose and high‐dose steroid treatment was 92 μm/day, 114 μm/day and 46 μm/day respectively. The growth rate during the high‐dose treatment was suppressed significantly compared to placebo treatment (95% CI ‐ 76 μm/day to ‐17 μm/day), whereas the growth rate during low‐dose steroid treatment was indistinguishable from placebo treatment (95% CI —7 to +52 μm/day). In conclusion, measurement of short‐term linear growth rate by knemometry in toddlers is a fast and gentle niethod with a high level of precision. The measurements may reflect systemic activity of steyoicttreatment, but probably do not indicate long‐term changes in statural height. Inhalation of a daily nominal dose of 200 μ g of budesonide did not affect short‐term growth, but an 800 μ g daily dose caused a slower short‐term growth. This study corroborates the safety of treating toddlers with budesonide 200 μ g inhaled from a spacer device, and indicates the importance of minimizing the dose.