Short-term growth and bone turnover in children with persistent asthma during inhaled steroid therapy

Although the change in therapy of bronchial asthma towards inhaled corticosteroids [ICS] is supported by both pathophysiological findings and efficacy data, its safety is often questioned. Many pediatricians are still concerned about the potential adverse effects of long-term treatment with inhaled corticosteroids, particularly on growth. As a result, this class of medication remains underused in children in many countries. The objective of this study is to compare the formation and degradation markers of bone turnover in asthmatic children who are using inhaled fluticasone propionate [FP]. The present study included 45 asthmatic children, of the age group 6-12 years, They were divided into two groups: Group 1: 26 patient with mild to moderate persistent asthma, receiving FP via pressurized metered dose inhalers [pMDI] at dosages equal to or below 200 mcg/day and Group II: 19 patients with moderate to severe persistent asthma, receiving FP at doses above 200 mcg/day. The study also included 14 healthy, nonatopic, non-asthmatic children as controls. All asthmatic children were subjected to: full medical history taking, symptom score calculation, thorough clinical examination, anthropometric measurements, Peak expiratory flow rate [PEFR] monitoring as well as pulmonary function testing before and after treatment, laboratory investigations including CBC with absolute eosinophilic count [AEC] calculation and total serum IgE once, serum calcium, phosphorous, alkaline phosphatase. Carboxy terminal of procollagen I [PICP] and Carboxy terminal telopeptide of type I collagen [ICTP] by radioimmunoassay as markers for bone formation and degradation respectively, before and after treatment with inhaled FP for 6 months. PICP and ICTP were also assessed once in controls. The results of the present work demonstrated a statistically significant decrease in asthma symptom score in both groups, as well as improvement of all asthma symptoms. A statistically significant increase in mean weight and height was observed in both groups that was within the normal percentiles. However, no statistically significant increase in mean body mass index [BMI] was demonstrated in either group. As regards pulmonary functions, a statistically significant increase in mean Forced expiratory volume in the first second [FEV[1]] Forced expiratory volume in the first second/Forced vital capacity [FEV[1]/FVC] and Forced expiratory flow through the midportion of the FVC [FEF[25-75]] was detected after treatment. No statistically significant difference between pre-and post-treatment mean values of serum calcium, phosphorous, and alkaline phosphatase was demonstrated. However, a statistically significant decrease was observed in post-treatment mean values of both PICP and ICTP as compared to pretreatment values with a significant positive correlation between both analytes implying a decrease in rate of bone turnover. No suppression of statural growth should occur in asthmatic children treated with inhaled FP if used at the conventional doses tailored to disease severity. A slowing down of bone turnover rate may occur, which is coupled for both formation and degradation markers. PICP and ICTP are sensitive markers that might be early indicators for potential growth suppression

relationship between viral antibodies and total IgE in sera of infants with recurrent viral-associated wheezing

Estimations of serum viral antibodies as well as total serum IgE were performed on 20 wheezy infants who presented with recurrent episodes of wheezing precipitated by respiratory infections as well as on 10 IgE and sex matched controls. A four folds rise in serum antibody titer was found in 85+ACU- of wheezy infants, in 60+ACU- for RSV, in 20+ACU- for PIV- 3, in 5+ACU- for ADV and in none for PIV-1. Three patients [15+ACU-] showed no antinbody rise for any of the viruses tested. Serum IgE in the RSV infected or PIV -3- infected wheezy infants was significantly elevated than that of controls. The significant positive correlation found between serum IgE serum viral antibodies in the RSV - infected or PIV -3 infected wheezy infants suggests that the rise in viral antibodies is at least partly due to IgE antibodies and that IgE- mediated hypersensitivity plays an important role in most cases of virus- associated wheezing. The presence of positive skin tests in 40+ACU- of our patients in association with high IgE and /or positive family or personal history of atopy may predict the subsequent development of asthma in such patients

Common inhalant allergens in extrinsic atopic asthmatic children in rural areas in Egypt

One hundred atopic asthmatic children from rural areas and 20 age matched atopic asthmatics from urban areas were studied. Among rural children, 27+ACU- started their symptoms in their first year of life, 54+ACU- before the age of 3 and 89+ACU- before the age of six. The male: female ratio was 0.96: 1. Thirty nine% had positive family history of allergy and 55+ACU- had positive personal history of associated atopic manifestations. On skin testing house dust, dust mites and mixed moulds were the commonest sensitizers in both urban and rural asthmatics. Feathers sensitivity was more common in urban children but sensitivities to hay dust, straw dust, mixed grass pollens, wheat grain pollens,plantain pollens, sheep wool and horse hair were higher among rural children. The differences were only significant with house dust, straw dust and wheat grain pollens