ADVERSE-EFFECTS OF INHALED BUDESONIDE (800 MU-G) 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 trea tment with 800 mu g of inhaled budesonide administered once daily in t he morning and 400 mu g administered twice daily. Patients: Twenty-fou r children with asthma aged 5.6 to 12.5 years. Setting: An outpatient secondary referral center. Methods: A randomized, double-blind, crosso ver trial with 2 treatment periods of 4 weeks was conducted, and growt h was assessed with a knemometer. The carboxy terminal propeptide of t ype 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 procollage n (PIIINP), and urinary pyridinoline and deoxypyridinoline were evalua ted. Results: Mean lower leg growth rate (P =.04), PINP (P =.03), and PIIINP (P <.01) were suppressed during twice-daily administration of b udesonide, 400 mu g. Otherwise, no statistically significant differenc es were detected. Conclusions: As compared with 400 mu g of inhaled bu desonide adminsitered twice daily, 800 mu g administered once daily in the morning has a sparing effect on short-term growth and collagen tu rnover.