Risk factors associated with glucocorticoid-induced adverse effects in children with severe asthma

Background: Although high-dose inhaled glucocorticoids (GCs) with or withou t chronically administered oral GCs are often used in children with severe persistent asthma, the adverse effects associated with their use have not b een well-described in this patient population. Objective: We sought to dete rmine the CC-induced adverse effects profile of older children with severe persistent asthma, Methods: A chart review of 163 consecutive children 9 years of age or older admitted to National Jewish for difficult to control asthma was done. Results: The population studied consisted mostly of adolescents (mean +/- S D age, 14.4 +/- 2.1 years) with severe asthma receiving high-dose inhaled G C therapy (1675 +/- 94 mug/d) and averaging 6 systemic GC bursts per year. 50% required chronic oral GC therapy. CC-associated adverse effects were co mmon and included hypertension (88%), cushingoid features (66%), adrenal su ppression (56%), myopathy (50%), osteopenia (46%), growth suppression (39%) , obesity and hypercholesterolemia (30%), and cataracts (14%), Height stand ard deviation scores of -0.44, -1.22, and -0.93 for those receiving intermi ttent, alternate day, and daily oral GCs, respectively, were smaller (less suppressed) than published values from the same institution before inhaled GC therapy (standard deviation scores of -1.26, -1.91, and -1.95, respectiv ely). Osteopenia was strongly associated with growth suppression (odds rati o, 5.6; confidence interval, 2.7-11.8; P <.0001) and was found to be more c ommon in female than male subjects, even after correcting for short stature (42% vs 18%, P <.006), Conclusions: CC-associated adverse effects are still unacceptably common am ong children with severe asthma, even in those not receiving chronically ad ministered oral GC therapy yet receiving high-dose Inhaled GCs. Therefore c lose monitoring and proper intervention are warranted, especially in female subjects, who appear to be at greater risk for osteopenia. There is clearl y a need to consider alternative therapy or earlier intervention. The magni tude of growth suppression, while still a problem, appeared to be less seve re with the addition of inhaled GC therapy. This observation suggests that high-dose inhaled GC therapy, by affording better asthma control and allowi ng less use of systemic therapy, has attenuated the growth-suppressive effe cts of poorly controlled asthma.