title: Side-effects of fluticasone in asthmatic children: no effects after dose reduction.
abstract: 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 microg.day(-1), with reductions every 2 months to 500, 200 and 100 microg.day(-1) for the remainder of the study) versus a constant dose (200 microg.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 microg.day(-1) FP followed by 500 microg.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 microg.day(-1) FP when compared with 200 microg.day(-1). In conclusion, doses of 1,000 and 500 microg.day(-1) fluticasone propionate are associated with marked reductions of growth velocity, bone turnover and adrenal cortical function. However, conventional doses (< or =200 microg.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.
authors.affiliation: Dept of Pulmonology, University Hospital Groningen, P.O.Box 30,001, 9700 RB, Groningen, the Netherlands. M.Visser@int.azg.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Visser
authors.forename: E
authors.initials: E
authors.lastname: van der Veer
authors.forename: D S
authors.initials: DS
authors.lastname: Postma
authors.forename: L R
authors.initials: LR
authors.lastname: Arends
authors.forename: T W
authors.initials: TW
authors.lastname: de Vries
authors.forename: P L P
authors.initials: PL
authors.lastname: Brand
authors.forename: E J
authors.initials: EJ
authors.lastname: Duiverman
mesh_terms: D000302:Adrenal Cortex / Q000187:drug effects; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects; D016535:Bronchial Hyperreactivity / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006128:Growth / Q000187:drug effects; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone