Biochemical markers of bone metabolism and bone mineral density during the.mt.al phase of inhaled corticosteroid therapy and the re. at. on of these changes to adrenal and growth suppression in children with persistent bronchial asthma

الملخص EN

Background: Inhaled corticosteroids are recognized as the most effective antiinflammatory therapy in patients with asthma and their early introduction is recommended by international guidelines.

Concerns have been raised about potential adverse effects of inhaled corticosteroids on bones, hypothalamic-pituitary-adrenal axis, and growth.

Aims: To evaluate the changes in biochemical markers pf bone metabolism, bon mineral density in relation to adrenal and growth suppression during the initij phase of inhaled steroid therapy.

Sixty asthmatic children were randomly divided into three treatment groups:20 to the budesonide (BUD), 20 to the fluticasone propionate (FP), and 20 to the sodium cromoglycate (CROM).BUD dose was 800 u.g /d during the firsttwo months and 400 u.g /d thereafter.

The respective FP does were 400 and 200 ug /d.

CROM dose was 20mg /d.

Methods: Biochemical markers of bone metabolism, were measured before treatment and after 2 and 4 months of therapy, BMD, was measured before treatment and after 4 months of therapy, a low dose ACTH (0.5 u.g/1.73m2) test was performed before treatment and 2 and 4 later, and follow up measurement of height for 12 months after starting asthma therapy.

Results: In the CROM group, the mean concentrations of serum osteocalcin (OC), carboxyterminal propeptide of type I procollagen (PlCP)fformation markers) and type I collagen carboxyterminal telopeptide (ICTP)fdegradation marker) tended to increase insignificantly.

In the BUD group, OC and PICP decreased significantly during the 4 months, while ICTP did not change significantly.

In the FP group, OC and ICTP decreased significantly during the firdt 2 months, returning to the pretreatment level at 4 months, while PICP tended to increase during the 4 months, No significant reduction in BMD in BUD &FP groups and it was comparable with control group at the beginning of the study and after 4 months.

The low dose ACTH test was abnormal after high steroid doses in 20% of the children and 15% in low steroid doses.

The mean annual growth was significant and similar in BUD, FP, and CROM groups.

Conclusion: Both inhaled BUD& FP caused dose-dependent effect on biochemical markers of bone metabolism.

We did not observed any side effects of ICSs on BMD and growth of asthmatic children.

The low dose ACTH test revealed mild adrenal suppression with no symptoms in fifth of the children.

AFP dose of 200 ug /d caused less effect on biochemical markers of bone metabolism and less adrenal suppression than did a BUD dose of 400 ug /d.