The linear relationship between changes in childhood growth velocity and topical glucocorticoid dose

The concept of therapeutic indices for glucocorticoid treatment of rhinitis and asthma requires demonstration of the dose dependency of benefits and s ide effects. Therefore, we examined the relationship between glucocorticoid dose and changes in growth velocity (Delta GV). The literature was reviewe d for articles where the net Delta GV could be calculated among steroid and parallel placebo, active treatment. or baseline run-in periods. Steroid do se and Delta GV were analyzed by linens regression for 5 rhinitis and 19 as thma studies using rapical budesonide, beclomethasone. fluticasone and mome tasone, parenteral steroids, and nonsteroid comparitors. Dose dependency wa s established between 0 and the equivalent of 2000 mug/day of beclomethason e (r(2) = 0.60). Delta GV was not significantly affected by 200 mug/day of BDP or less. Nasal and bronchial administrations apl,eared to give equivale nt responses. Growth suppression occurred rr within 2 weeks, and may be lin ked to a delay in the onset of puberty. The physiology of these effects was discussed.