Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone

• Published in: Journal of allergy and clinical immunology 2011-11, Vol.128 (5), p.956-963.e7
• Main Authors: Guilbert, Theresa W., MD, Mauger, David T., PhD, Allen, David B., MD, Zeiger, Robert S., MD, PhD, Lemanske, Robert F., MD, Szefler, Stanley J., MD, PhD, Strunk, Robert C., MD, Bacharier, Leonard B., MD, Covar, Ronina, MD, Sorkness, Christine A., PharmD, Taussig, Lynn M., MD, Martinez, Fernando D., MD
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Allergy and Immunology; Androstadienes - adverse effects; Androstadienes - therapeutic use; Anti-Asthmatic Agents - adverse effects; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - prevention & control; Asthma Predictive Index; atopy; Biological and medical sciences; Body Height - drug effects; Body Weight - physiology; Child, Preschool; Chronic obstructive pulmonary disease, asthma; clinical trials; Cohort Studies; Double-Blind Method; early childhood asthma; Family medical history; Female; Fluticasone; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hispanic people; Humans; Immunopathology; inhaled corticosteroids; intermittent wheezing; linear growth; Male; Medical sciences; Medical treatment; Pneumology; research network; Respiratory Sounds; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Statistical methods; Studies
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2011.06.027

Background The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial. Objective We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing. Methods Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups. Results In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, −0.2 cm; 95% CI, −1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, −1.6 cm; 95% CI, −2.8 to −0.4; P  = .009). Conclusion Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.