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ISSN 1405-1699 (Print)
Órgano Oficial del Colegio Mexicano de Alergia, Asma e Inmunología Pediátrica y de la Asociación Latinoamericana de Pediatría

2009, Number 3

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Alerg Asma Inmunol Pediatr 2009; 18 (3)

Inverse relationship between the treatment scheme (dose, frequency and type) with inhaled steroids and linear growth in children suffering from asthma

Huerta LJ, Jiménez GC, Del Olmo TH, Leonor SA

Language: Spanish
References: 32
Page: 90-112
PDF size: 401.56 Kb.


ABSTRACT

Background: Chronic inflammation is associated with the increase of airway hyperreactivity. This condition leads to recurrent episodes of sibilance, dyspnea, thoracic oppression, and cough, especially during the night or early in the morning. It is estimated that there are 300 million people affected. The prevalence of asthma reported by GINA (Global Initiative for Asthma) ranges from the 1% to the 18% of the population in different countries. The World Health Organization (WHO) has estimated that 15 million years of life have been lost due to asthma. This figure represents the 1% of the total global burden generated by this disease. Linear growth is defined as the growth of body weight along time; that is to say, of the corporal composition according to age. The growth monitoring is performed through somatometry and the analysis of the body characteristics, comparing the findings to the population parameters that have been described as habitual according to sex and age. The follow-up of the nutritional condition primarily presents the objective of observing progress, stability and or deterioration of anthropometric variables or indicators along time. The aim of the aforementioned fact is to alert about some undesirable situations, and to measure or assess the consequences of plans and programs. Glucocorticoids present a preferential place in the management of diverse diseases because their therapeutic performance is very high, but frequently their clinical use is accompanied by undesirable consequences that sometimes are serious. When they are used through the inhalatory route, just the 20% of the dose of the glucocorticoids used is achieved as pulmonary accumulation. From the remaining 80%, a variable part is swallowed; nevertheless, there is a systemic availability of the drug. Therefore, inhaled steroids are not exempt of side effects. The risks from the systemic effects depend on certain factors: drug bioavailability, suppressor power of the hypothalamic- hypophyseal (pituitary)-adrenal axis, the first step in liver metabolism, average lifetime, and the used dose. In physiological doses, steroids induce growth, working in a synergic way along with other factors. A catabolic and inhibiting effect of linear growth is evident when steroids are given in high doses and especially when they are administered during long periods. The indirect effects are mediated by cytokines, growth factors, and calcium-tropic hormones, as well as a reduced level of the type 1 insulin-like growth factor binding protein-1. High concentrations of steroids inhibit the production of type I and III collagen through fibroblasts, as well as the generation of glucosaminoglycan, affecting this way the formation of the matrix, and the extra-cellular collagen. The administration in vivo of glucocorticoids to children produces a decrease in the serum levels of type I procollagen in 24 hours. This previously mentioned fact leads to a block of linear growth, in an effect related to the dose and the interval of administration. Steroids delay the epiphyseal closure, contributing to delayed osseous maturation, which is characteristic of children who have been treated with high doses. Objectives: To establish if the therapy by means of inhaled steroids is a cause for linear growth decrease in children presenting asthma. Material and methods: It will be performed reviews of: meta-analysis, randomized systematic reviews, controlled double-blind studies, transversal studies, cohort cases and controls, clinical studies, and narrative reviews including the following criteria: individuals being younger than 18 years old, from both sexes, with an established diagnosis of mild and moderate asthma, and patients that had not received steroids in a systemic way and who present use of inhaled steroids for a minimum of 3 months. The seeking time will be from 10 years ago up to date. The level of evidence according Oxford guideline will be used.


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