title: Height growth in children with asthma treated with guideline-recommended dosages of fluticasone and electronically assessed adherence.
abstract: Inhaled corticosteroids (ICS) reduce growth during the first year of treatment, but this growth suppressing effect does not continue during further treatment. Decreasing adherence may play a role in explaining this. The aim of this study was to examine the relationship between cumulative real exposure (with objectively assessed adherence) to ICS and height growth in children with asthma.
  
  
  
  We investigated 99 prepubertal children with asthma, 2-13 years of age, who had been using ICS in guideline-recommended dosages for ≥3 months, and continued to do so during 1-year follow-up. ICS adherence was assessed by electronic monitoring devices, allowing calculation of true cumulative exposure to ICS. We analysed the relationship between cumulative ICS dose and height growth velocity (assessed as change in height SD score) over 1 year.
  
  
  
  Median (IQR) adherence over 1 year was 84 (68-92) %. Mean cumulative fluticasone dose was 64.6 (SD, 27.8) mg, reflecting a daily dose of 167 (SD, 7) µg. The negative correlation between cumulative ICS dose and height growth velocity (r=-0.266; p=0.008) became non-significant after adjustment for age and sex in a multiple regression model (adjusted r=-0.188; p=0.066).
  
  
  
  One year of ICS treatment in guideline-recommended dosages with high adherence did not result in significant or relevant growth suppression. Unaffected growth can be maintained for at least 1 year in children with asthma during ICS treatment with high adherence.
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands Department of Paediatrics, AZ-St-Jan Bruges-Ostend AV, Bruges, Belgium.
authors.forename: Nele R A
authors.initials: NR
authors.lastname: Wardenier
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands Department of Paediatric Allergology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Ted
authors.initials: T
authors.lastname: Klok
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: de Groot
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, The Netherlands.
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001827:Body Height / Q000187:drug effects; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D000068298:Fluticasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006130:Growth Disorders / Q000139:chemically induced*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016903:Drug Monitoring
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D000068298:Fluticasone
keywords: Growth; Respiratory