Η επίδραση των εισπνεόμενων κορτικοειδών στο ύψος των παιδιών με βρογχικό άσθμα

Kelly HW, Sternberg AL, Lescher R, Fuhlbrigge AL, Williams P, Zeiger RS, Raissy HH, Van Natta ML, Tonascia J, Strunk RC; CAMP Research Group.

Effect of inhaled glucocorticoids in childhood on adult height.

N Engl J Med. 2012 Sep 6;367(10):904-12.

Abstract

BACKGROUND:

The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height.

METHODS:

We measured adult height in 943 of 1041 participants (90.6%) in the Childhood Asthma Management Program; adult height was determined at a mean (±SD) age of 24.9±2.7 years. Starting at the age of 5 to 13 years, the participants had been randomly assigned to receive 400 μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years. We calculated differences in adult height for each active treatment group, as compared with placebo, using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry.

RESULTS:

Mean adult height was 1.2 cm lower (95% confidence interval [CI], -1.9 to -0.5) in the budesonide group than in the placebo group (P=0.001) and was 0.2 cm lower (95% CI, -0.9 to 0.5) in the nedocromil group than in the placebo group (P=0.61). A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (-0.1 cm for each microgram per kilogram of body weight) (P=0.007). The reduction in adult height in the budesonide group as compared with the placebo group was similar to that seen after 2 years of treatment (-1.3 cm; 95% CI, -1.7 to -0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in prepubertal participants.

CONCLUSIONS:

The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height, although the decrease was not progressive or cumulative.

(Funded by the National Heart, Lung, and Blood Institute and the National Center for Research Resources; CAMP ClinicalTrials.gov number, NCT00000575.).

http://www.nejm.org/doi/full/10.1056/NEJMoa1203229

Η μακροχρόνια θεραπεία του βρογχικού άσθματος με εισπνεόμενα κορτικοειδή στην προεφηβική ηλικία έχει συσχετισθεί με επιβράδυνση στην αύξηση του ύψους αυτών των παιδιών. Σε αυτήν την κλινική μελέτη του Εθνικού Ινστιτούτου Υγείας των Ηνωμένων Πολιτειών διερευνήθηκε η μακροπρόθεσμη επίπτωση των εισπνεόμενων κορτικοειδών στο τελικό ύψος 943 – ενήλικων πλέον – ασθενών της μελέτης CAMP, οι οποίοι είχαν τυχαιοποιηθεί να λάβουν είτε βουδεσονίδη (400 µg/ημέρα), είτε nedocromil (16 mg/ημέρα), είτε εικονικό φάρμακο (placebo) για 4 με 6 χρόνια, από την ηλικία των 5 έως 13 ετών.

Μετρήθηκε το ύψος σε ασθενείς με μέση ηλικία τα 25 έτη.

Το ύψος των ασθενών οι οποίοι έλαβαν βουδεσονίδη ήταν κατά μέσο όρο 1,2 εκατοστά λιγότερο από τους ασθενείς οι οποίοι έλαβαν εικονικό φάρμακο. Μεγαλύτερη ημερήσια δόση βουδεσονίδης συσχετίσθηκε με χαμηλότερο ύψος, παρατηρήθηκε στα πρώτα δύο χρόνια από την έναρξη της αγωγής και δεν επιδεινώθηκε μετά από αυτό το χρονικό διάστημα.

Συμπερασματικά, η θεραπεία με εισπνεόμενη βουδεσονίδη στην προεφηβική ηλικία οδηγεί σε μία ήπια ελλάτωση του τελικού ύψους σε παιδιά με βρογχικό άσθμα.

Επιπλέον σχόλια :

National Heart Lung and Blood Institute Press Release :

NIH-funded study finds potential small effect on growth rate should be balanced against proven health benefits .

http://www.nhlbi.nih.gov/news/press-releases/2012/inhaled-corticosteroids-for-childhood-asthma-may-affect-adult-height.html

Adults who had been treated previously with the inhaled corticosteroid budesonide as part of a children’s clinical study were, on average, about half an inch shorter than their study counterparts who were not treated with inhaled corticosteroids, according to research funded by the National Institutes of Health. The half inch difference had been observed when the study participants were children, showing that, while the effect on height does not go away, it also does not get worse, the researchers say.

Journal Watch :

Inhaled Glucocorticoids for Childhood Asthma Modestly Reduce Adult Height.

Mean adult height was 1.2 cm lower in those who used budesonide during childhood.

http://pediatrics.jwatch.org/cgi/content/full/2012/904/1