Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device.
BACKGROUND
The objective was to investigate the local side-effects of inhaled corticosteroids (ICS) in daily life in asthmatic children, particularly the younger ones, by an observational prospective cross-sectional cohort study.


METHODS
Asthmatic children (n=639, 75.9+/-48.9 months, 61.3% boys), treated with beclomethasone dipropionate (BDP) (721.0+/-287.3 microg per day) or budesonide (BUD) (835.5+/-684.9 microg per day) for at least 1 month, were recruited at the time of a scheduled visit. Local side-effects were researched by questionnaire (cough during inhalation, hoarseness, dysphonia, and thirsty feeling) and clinical examination (perioral dermatitis, oral candidiasis, and tongue hypertrophy).


RESULTS
Exactly 63.3% of the children aged under 6 years and 59.5% of the older ones reported one local side-effect. Cough (39.7%) was dependent on young age, use of BDP, and mainly use of spacer device, with an OR of 4.7 (95% CI: 2.7-8.2). Thirsty feeling (21.9%) and hoarseness (14.1%) occurred in children using ICS and long-acting beta2-agonists. Dysphonia (11.1%) was favored by high doses of BDP and BUD, and by inhalation from spacer devices or nebulizers. No factor favored oral candidiasis (10.7%). Perioral dermatitis (2.9%) and tongue hypertrophy (0.1%) were associated with nebulization.


CONCLUSIONS
Local side-effects of ICS are common in asthmatic children of all ages, and the device used constitutes the most influential factor.
Dubus
J C
JC
Services de Pédiatrie, CHU Timone-Enfants, Marseille, Hôpital Charles Nicolle (Rouen), Hôpital Jeanne de Flandres (Lille), Hôpital du Havre (Le Havre), CH Côte de Nâcre (Caen), INSERM U379, Institut Paoli-Calmette, Marseille, France.
Marguet
C
C
Deschildre
A
A
Mely
L
L
Le Roux
P
P
Brouard
J
J
Huiart
L
L
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000367:Age Factors; D001249:Asthma / Q000188:drug therapy*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009059:Mouth Diseases / Q000139:chemically induced*; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000139:chemically induced*; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones