To assess long-term effects and side-effects of fluticasone propionate (FP), a 2-yr study was performed, comparing a step-down dose approach (1,000 mug.day(-1), with reductions every 2 months to 500, 200 and 100 mug.day(-1) for the remainder of the study) versus a constant dose (200 mug.day(-1)).
In 55 children with chronic persistent asthma, aged 6-10 yrs, airways hyperresponsiveness (AHR) and systemic side-effects (height, bone parameters and adrenal cortical function) were assessed at predetermined intervals in a double-blind prospective 2-yr study.
AHR improved after 4 months treatment with 1,000 mug.day(-1) FP followed by 500 mug.day(-1) without significant differences during long-term treatment between the two approaches. Dose-dependent reduction of growth velocity, adrenal cortical function and biochemical bone turnover was found during therapy with 1,000 and 500 mug.day(-1) FP when compared with 200 mug.day(-1).
In conclusion, doses of 1,000 and 500 mug.day(-1) fluticasone propionate are associated with marked reductions of growth velocity, bone turnover and adrenal cortical function. However, conventional doses (less than or equal to200 mug.day(-1) fluticasone propionate) appear to be safe in the long-term management of childhood asthma. From a safety point of view, high doses of fluticasone propionate should only be prescribed in exceptions, e.g. in persistent severe asthma.
|Number of pages||6|
|Journal||European Respiratory Journal|
|Publication status||Published - Sep-2004|
- adrenal cortex
- bone metabolism
- BONE-MINERAL DENSITY
- LONG-TERM TREATMENT
- INHALED CORTICOSTEROIDS
- ADRENAL SUPPRESSION
- CHILDHOOD ASTHMA