RESUMO
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