Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone

Theresa W. Guilbert, David Mauger, David B. Allen, Robert S. Zeiger, Robert F. Lemanske, Stanley J. Szefler, Robert C. Strunk, Leonard B. Bacharier, Ronina Covar, Christine A. Sorkness, Lynn M. Taussig, Fernando D. Martinez

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Abstract

Background: The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial. Objective: We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing. Methods: Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups. Results: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, -0.2 cm; 95% CI, -1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, -1.6 cm; 95% CI, -2.8 to -0.4; P =.009). Conclusion: Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology
Volume128
Issue number5
DOIs
StatePublished - Jan 1 2011

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Preschool Children
Asthma
Respiratory Sounds
Growth
Placebos
Chlorofluorocarbons
Adrenal Cortex Hormones
Cohort Studies
Therapeutics
Masks
Fluticasone
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Guilbert, Theresa W. ; Mauger, David ; Allen, David B. ; Zeiger, Robert S. ; Lemanske, Robert F. ; Szefler, Stanley J. ; Strunk, Robert C. ; Bacharier, Leonard B. ; Covar, Ronina ; Sorkness, Christine A. ; Taussig, Lynn M. ; Martinez, Fernando D. / Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone. In: Journal of Allergy and Clinical Immunology. 2011 ; Vol. 128, No. 5.
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title = "Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone",
abstract = "Background: The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial. Objective: We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing. Methods: Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups. Results: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, -0.2 cm; 95{\%} CI, -1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, -1.6 cm; 95{\%} CI, -2.8 to -0.4; P =.009). Conclusion: Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.",
author = "Guilbert, {Theresa W.} and David Mauger and Allen, {David B.} and Zeiger, {Robert S.} and Lemanske, {Robert F.} and Szefler, {Stanley J.} and Strunk, {Robert C.} and Bacharier, {Leonard B.} and Ronina Covar and Sorkness, {Christine A.} and Taussig, {Lynn M.} and Martinez, {Fernando D.}",
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Guilbert, TW, Mauger, D, Allen, DB, Zeiger, RS, Lemanske, RF, Szefler, SJ, Strunk, RC, Bacharier, LB, Covar, R, Sorkness, CA, Taussig, LM & Martinez, FD 2011, 'Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone', Journal of Allergy and Clinical Immunology, vol. 128, no. 5. https://doi.org/10.1016/j.jaci.2011.06.027

Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone. / Guilbert, Theresa W.; Mauger, David; Allen, David B.; Zeiger, Robert S.; Lemanske, Robert F.; Szefler, Stanley J.; Strunk, Robert C.; Bacharier, Leonard B.; Covar, Ronina; Sorkness, Christine A.; Taussig, Lynn M.; Martinez, Fernando D.

In: Journal of Allergy and Clinical Immunology, Vol. 128, No. 5, 01.01.2011.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone

AU - Guilbert, Theresa W.

AU - Mauger, David

AU - Allen, David B.

AU - Zeiger, Robert S.

AU - Lemanske, Robert F.

AU - Szefler, Stanley J.

AU - Strunk, Robert C.

AU - Bacharier, Leonard B.

AU - Covar, Ronina

AU - Sorkness, Christine A.

AU - Taussig, Lynn M.

AU - Martinez, Fernando D.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background: The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial. Objective: We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing. Methods: Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups. Results: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, -0.2 cm; 95% CI, -1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, -1.6 cm; 95% CI, -2.8 to -0.4; P =.009). Conclusion: Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.

AB - Background: The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial. Objective: We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing. Methods: Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups. Results: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, -0.2 cm; 95% CI, -1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, -1.6 cm; 95% CI, -2.8 to -0.4; P =.009). Conclusion: Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.

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