RESUMEN
Inhaled corticosteroids [ICSs] are the most effective asthma therapy, and therefore the recommended treatment for persistent asthma at any step of severity. Nowadays, they are prescribed more frequently and in higher doses than previously in the management of children with persistent asthma. Although these drugs have less potential for systemic impact than oral steroids, some recent studies in bone mineral density suggest that they are not devoid of systemic side effects. The aim of this study was to evaluate the effect of Iong-term treatment of asthmatic children with moderate dose inhaled corticosteroid [Fluticasone propionate, FP] on bone mineral density [BMD].The study was a cross-sectional one and was conducted on a total of 60 children [5-11 years old]; 30 with stable moderate persistent asthma on regular FP for 6-48 months, at a dose of 250-500 mg/day via a metereddose inhaler [MDI] plus spacer with mouthpiece and 30 healthy non-asthmatic control children of matched age and sex. All study population were subjected to measurement of BMD of L2-L4 vertebrae and nondominant proximal radius by dual-energy X-ray absorptiometry [DXA]. Analysis of the results showed that: [1]. All BMD measures [gm/cm2, % of age-matched nonnative data, and Z-score] of L2-L4 vertebrae and radius BMD [gm/cm2] were slightly but not significantly lower in asthmatic children than in healthy controls [L2-L4: t=0.33, ' P=0.849, t=1.998; P=0.246 and t=2.933 P=0.094, Radius t=0.644; P=0.622 respectively]. [2]. All asthmatic children but one [966%] had a normal Z-score of L2-L4 [within 2 SD of the mean for age-matched normative data]. [3]. No significant correlation between the BMD of L2-L4 vertebrae or radius and the daily dose of FP [r=0.030 P=0.874 and r=0.315 P=0.090]. [4]. A significant negative correlation between L2-L4 BMD and both the duration and the cumulative dose of FP [r=-0.694; P<0.001, and r=-0.669, ' P<0.001], such correlation was not signifIcant with respect to radius BMD [r=-0.338 P=0.067. r=-0.223 P=0.237]
Conclusions: 6-48 months treatment with a moderate dose of FP has no significant adverse effect on BMD in Prepubertal asthmatic children with moderate persistent asthma
RESUMEN
The primary therapies for acute asthma exacerbations are the administration of a rapid-acting beta 2 agonist, the early introduction of systemic glucocorticosteroids, and oxygen supplementation. The aim of this study was to test the effectiveness of dexamethasone when given by inhalation in combination with saibutamol in the treatment of acute asthma attacks of moderate severity and to compare it with systemic steroids given by conventional methods, namely, the oral and parenteral routes. The study was conducted on a total of 60 children, 1 to 12 years old, with a history of stable bronchial asthma and suffering from acute exacerbations of moderate severity. Asthmatic children were divided at random into 3 equal groups each of 20, and within 5 minutes of their first saibutamol nebulization, they were given either [a] Nebulized dexamethasone in a dose of 1mg/kg, maximum 16mg [group I], [b] Oral prednisone in a dose of 1mg/kg [group II], or [c] Intravenous hydrocortisone in a dose of 4 mg/kg [group III]. Nebulized saibutamol was repeated for all patients an hourly basis for 3 hours and later every 2 hours. Comparison was made between the three groups by repeating a pulmonary index [PI] score at 3 and 6 hours after steroid administration. Assessment after 3 hours revealed that: [1]. The mean PI and respiratory rate in the dexamethasone group were significantly lower than in the oral prednisone group with no significant difference in these parameters between the dexamethasone and the parenteral hydrocortisone group. [2]. There was a significant improvement in the PI, respiratory rate, and oxygen saturation in all studied groups when compared to baseline data. Assessment after 6 hours revealed no statistically significant differences between the three studied groups as regards the PI, respiratory rate, and oxygen saturation. Conclusion: Dexamethasone, when given by inhalation in combination with saibutamol is at least as effective as oral and parenteral steroids for first line therapy of acute asthma exacerbations of moderate severity, moreover, it is associated with more rapid improvement when compared to oral steroids