title: Lower leg growth suppression caused by inhaled glucocorticoids is not accompanied by reduced thickness of the cutis or subcutis.
abstract: BACKGROUND
  Exogenous glucocorticoids suppress short-term lower leg growth in children as assessed by knemometry. The knemometric measurements, however, may be confounded by reductions in the thickness of the cutis and subcutis over the knee.
  
  
  OBJECTIVE
  To assess whether inhaled glucocorticoid-induced suppression of short-term growth is accompanied by changes in the thickness of the cutis and subcutis.
  
  
  METHODS
  The study was a randomized, controlled, crossover trial with 1 wk treatment, run-in and washout periods. Active treatment was inhaled budesonide 200 microg twice daily. Short-term growth was assessed by knemometry, and the thickness of the cutis and subcutis over the knee, on the volar forearm and abdomen was measured by 20 MHz B-mode ultrasound.
  
  
  METHODS
  Nineteen children with asthma aged 7 to 13 y.
  
  
  RESULTS
  Lower leg growth was significantly reduced during budesonide treatment (0.27 mm/wk) compared to the treatment-free period (0.54 mm/wk) (p = 0.02, 95%: -0.50 to -0.05). Variations in the thickness of the cutis were seen during budesonide treatment (mean +/- SEM): -0.01 +/- 0.03 mm over the knee, -0.02 +/- 0.02 mm on the forearm and 0.01 +/- 0.02 mm on the abdomen. The variations in the total thickness of the cutis and subcutis were -0.05 +/- 0.12 mm, 0.06 +/- 0.12 mm and -0.06 +/- 0.10 mm during budesonide treatment. The variations in thickness of the cutis or subcutis were not statistically different during budesonide treatment and the treatment free period in any anatomical location.
  
  
  CONCLUSIONS
  Short-term lower leg growth suppression induced by inhaled glucocorticoids is not confounded by variations in thickness of cutis or subcutis. The present observations further establishes knemometry as a reliable tool for assessment of the risk of growth suppression of inhaled glucocorticoids in children with asthma.
authors.affiliation: Children's Clinic, Randers, Denmark. ajs@dadlnet.dk
authors.forename: A J
authors.initials: AJ
authors.lastname: Schou
authors.forename: A M
authors.initials: AM
authors.lastname: Plomgaard
authors.forename: K
authors.initials: K
authors.lastname: Thomsen
authors.forename: O D
authors.initials: OD
authors.lastname: Wolthers
mesh_terms: D000005:Abdomen / Q000503:physiopathology; D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology; D019819:Budesonide / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D005542:Forearm / Q000503:physiopathology; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006128:Growth / Q000187:drug effects; D006801:Humans; D007717:Knee / Q000503:physiopathology; D007866:Leg / Q000503:physiopathology*; D008297:Male
chemical_list: D005938:Glucocorticoids; D019819:Budesonide