Abstract:
Background: Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma.
However adverse effects of ICS on Hypothalamo Pituitary Adrenal (HPA) axis, growth and bone metabolism are a
concern. Hence the primary objective of this study was to describe the effects of long term inhaled corticosteroid
therapy (ICS) on adrenal function, growth and bone health in children with asthma in comparison to an age and
sex matched group of children with asthma who were not on long term ICS. Describing the association between
the dose of ICS and duration of therapy on the above parameters were secondary objectives.
Method: Seventy children with asthma on ICS and 70 controls were studied. Diagnosis of asthma in selected
patients was reviewed according to the criteria laid down by GINA 2018 guidelines. The estimated adult heights
were interpreted relative to their Mid Parental Height (MPH) range. Serum calcium, alkaline phosphatase and
vitamin D levels were analyzed in both groups and cortisol value at 30 min following a low dose short synacthen
test was obtained from the study group. The average daily dose of ICS (Beclamethasone) was categorized as low,
medium and high (100–200, 200–400, > 400 μg /day) respectively according to published literature.
Results: Heights of all children were within the MPH range. There was no statistically significant difference in the
bone profiles and vitamin D levels between the two groups (Ca: p = 0.554, vitamin D: p = 0.187) but vitamin D levels
were insufficient (< 50 nmol/l) in 34% of cases and 41% of controls. Suppressed cortisol levels were seen in 24%.
Doses of ICS were low, medium and high in 56, 32 and 12% of children respectively. The association between
adrenal suppression with longer duration of therapy (p < 0.01) and with increasing dose of ICS (p < 0.001) were
statistically significant.
Conclusion: ICS had no impact on the growth and bone profiles but its dose and duration were significantly
associated with adrenal suppression.
Keywords: Asthma, Inhaled corticosteroids, Growth, Adrenal suppression, Bone metabolism, Vitamin D
