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  Authority of Polish Society of Allergology

vol 13. no 4. December 2008  

 Original articles
Effect of one year treatment with inhaled budesonide on bone density and mineralization in children with bronchial asthma
Najberg, Anna Smorczewska-Kiljan, Janusz Książyk, Elżbieta Kaczmarewicz, Paweł Płudowski, Maciej Jaworski, Halina Matusik, Edyta Kryśkiewicz

Introduction. The basic agent of treating bronchial asthma is inhaled glucocorticosteroids (IGCS). The safety of the long-term application of IGCS has been a matter of controversy, especially in the case of children.
Aim of the study. Assessment of the effects of one-year treatment with budesonide on bone density and mineralisation.
Material and methods. The study has been conducted on a group of 44 children (26 boys and 18 girls) between 5 and 11.8 years of age (with the average age of 7.1 years) shortly following diagnosed bronchial asthma. The treatment administered served as the rationale for the qualification the patients to be put into two groups: group I (30 children) has received budesonide inhalations at 200-400µg/24h for 12 months; the control group II (of 14 children) has received treatment without IGCS. Prior to the treatment, as well as 6 and 12 months after the treatment started, the following biochemical markers of bone metabolism were checked: osteocalcin (OC) and cross-linked C-terminal telopeptide of type I collagen (CTx). In addition, the DXA (Dual Energy X-ray Absorptiometry) densitometry was performed.
Results. After 6 and 12 months of therapy, no difference was found in the average OC and CTx levels between the IGCS (I) and non-IGCS (II, control) groups. An increase in the CTx level (p=0.028) was noted in the sixth month of the treatment in the children subjected to budesonide. After six months, both groups displayed a significant increase in the OC level. However, there was no major difference in the B MD and Z-score index between the groups. Throughout the 12 months of treatment, the bone density of the IGCS group (I) was increasing at the same ratio as of the control group, while Z-score values remained unchanged for both groups.
Conclusions. Although the administration of budesonide at 200-400 µg/24h to the asthmatic children did not increase the bone mineralisation disorders throughout 1 year of time, the diagnosed characteristics of an increased bone tissue resorption suggest further surveillance of such patients, especially in the context of long-term administration of IGCS.

keywords: astma, dzieci, metabolizm kostny, steroidy wziewne, asthma, bone mineralisation, children, inhaled corticosteroids

pages: from 217 to 226

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