PMID- 9648973
OWN - NLM
STAT- MEDLINE
DCOM- 19980901
LR  - 20190822
IS  - 0903-1936 (Print)
IS  - 0903-1936 (Linking)
VI  - 11
IP  - 5
DP  - 1998 May
TI  - Effect of inhaled corticosteroids on bones and growth.
PG  - 1167-77
AB  - Inhaled corticosteroids are recognized as the most effective anti-inflammatory 
      therapy in patients with asthma and their early introduction is recommended by 
      national and international guidelines. Concerns have been raised about potential 
      adverse effects of inhaled corticosteroids on bones and growth, as these appear 
      to be more important clinically than effects on the 
      hypothalamic-pituitary-adrenal axis, which are more commonly measured. This 
      review examines the effects of inhaled corticosteroids on biochemical bone 
      markers, bone density and growth in adults and children with asthma, in view of 
      the recent availability of a substantial amount of new clinical trial data. 
      Examination of relevant retrospective and prospective data, involving 11 studies 
      (1,240 patients) on biochemical bone markers and 14 studies (373 patients) on 
      bone density over a wide dose range, have largely indicated no significant or 
      clinically important effect on these measurements in adults or children with 
      asthma. Markers of bone formation and resorption need to be measured concurrently 
      for a reliable assessment of bone turnover to be made. Knemometry, measuring 
      lower leg growth rate, is a sensitive technique for comparing the systemic 
      activity of different inhaled corticosteroids, but does not relate to long-term 
      growth. The majority of approximately 40 studies on inhaled corticosteroids and 
      statural growth in children, over a wide recommended dose range, including a 
      number of recent long-term, prospective studies, demonstrate little or no effect. 
      Children taking above recommended doses of inhaled corticosteroids should have 
      their growth monitored using stadiometry at least every 6 months by trained 
      personnel. Most of the areas reviewed, particularly the relatively new areas of 
      biochemical bone markers and bone density, require further properly controlled, 
      long-term, prospective investigation, although the long-term value of bone 
      markers appears limited. In summary, the data as it currently stands, suggests 
      that doses of inhaled corticosteroids up to 1,000 microg x day(-1) in adults and 
      400 microg x day(-1) in children have no significant effect on bones and growth 
      in the large majority of patients with asthma.
FAU - Efthimiou, J
AU  - Efthimiou J
AD  - Dept of Respiratory Medicine, Glaxo Wellcome Research and Development, Middlesex, 
      UK.
FAU - Barnes, P J
AU  - Barnes PJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Eur Respir J
JT  - The European respiratory journal
JID - 8803460
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
CIN - Eur Respir J. 1999 Mar;13(3):707-9. PMID: 10232453
MH  - Administration, Inhalation
MH  - Adrenal Cortex Hormones/*administration & dosage/*adverse effects
MH  - Asthma/drug therapy
MH  - Bone Density/drug effects
MH  - Bone and Bones/*drug effects/metabolism
MH  - Growth/*drug effects
MH  - Humans
MH  - Nebulizers and Vaporizers
RF  - 107
EDAT- 1998/07/02 00:00
MHDA- 1998/07/02 00:01
CRDT- 1998/07/02 00:00
PHST- 1998/07/02 00:00 [pubmed]
PHST- 1998/07/02 00:01 [medline]
PHST- 1998/07/02 00:00 [entrez]
AID - 10.1183/09031936.98.11051167 [doi]
PST - ppublish
SO  - Eur Respir J. 1998 May;11(5):1167-77. doi: 10.1183/09031936.98.11051167.