Adverse effects of inhaled budesonide (800 μg) on growth and collagen turnover in children with asthma:: A double-blind comparison of once-daily versus twice-daily administration

Background: Twice-daily administration of inhaled budesonide (400 mu g) suppresses short-term growth in children with asthma. Objective: To compare short-term growth and markers of collagen turnover during treatment with 800 mu g of inhaled budesonide administered once daily in the morning and 400 mu g administered twice daily. Patients: Twenty-four children with asthma aged 5.6 to 12.5 years. Setting: An outpatient secondary referral center. Methods: A randomized, double-blind, crossover trial with 2 treatment periods of 4 weeks was conducted, and growth was assessed with a knemometer. The carboxy terminal propeptide of type I procollagen, the amino terminal propeptide of type I procollagen (PINP), the carboxy terminal pyridinoline cross-linked telopeptide of type I collagen, the amino terminal propeptide of type III procollagen (PIIINP), and urinary pyridinoline and deoxypyridinoline were evaluated. Results: Mean lower leg growth rate (P =.04), PINP (P =.03), and PIIINP (P <.01) were suppressed during twice-daily administration of budesonide, 400 mu g. Otherwise, no statistically significant differences were detected. Conclusions: As compared with 400 mu g of inhaled budesonide adminsitered twice daily, 800 mu g administered once daily in the morning has a sparing effect on short-term growth and collagen turnover.