The effect of inhaled corticosteroids on the urinary calcium to creatinine ratio in childhood asthma.
BACKGROUND
The use of inhaled corticosteroids (ICS) via spacers in childhood asthma is increasing. However, concern has been raised about its long-term impact. Hypercalciuria is a known adverse effect of treatment with systemic corticosteroids. The urinary calcium to creatinine ratio (UCa:Cr) is a simple, reliable and non-invasive tool for evaluation of hypercalciuria.


OBJECTIVE
To determine whether ICS can induce hypercalciuria in children with asthma.


METHODS
Outpatient clinic in a referral hospital.


METHODS
The UCa:Cr was determined in 25 children aged 3-6 years with mild-to-moderate persistent asthma before and after a 2-month course of inhaled budesonide 400 micrograms/day via an aerochamber. Children who had received oral corticosteroids, diuretics, antibiotics or theophylline were excluded.


METHODS
Paired Student's t-test and Fisher's exact test.


RESULTS
The mean UCa:Cr was similar in the children with asthma before and after 2 months' administration of budesonide (0.10 +/- 0.10 and 0.11 +/- 0.08, respectively; p = 0.601). The numbers of hypercalciuric children were two and five, respectively (p = 0.417). In 68% of patients, the UCa:Cr increased and in 16% the increase indicated hypercalciuria (UCa:Cr > 0.2).


CONCLUSIONS
Although the treatment of childhood asthma with budesonide 400 micrograms/day via an aerochamber does not appear to be associated with hypercalciuria, the existence of a subgroup of patients in whom ICS may induce hypercalciuria is plausible. This needs to be further evaluated in a larger study.
Bentur
Lea
L
Pediatric Pulmonology Unit, Israel Poison Information Center, Haifa, Israel. d_bentur@rambam.health.gov.il
Taisir
Jarrous
J
Bentur
Yedidia
Y
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000493:pharmacokinetics*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001249:Asthma / Q000150:complications / Q000652:urine*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use; D002118:Calcium / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D019819:Budesonide; D003404:Creatinine; D002118:Calcium