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Asthma
Original research
Height and bone mineral content after inhaled corticosteroid use in the first 6 years of life
  1. Asja Kunøe1,
  2. Astrid Sevelsted1,
  3. Bo L K Chawes1,
  4. Jakob Stokholm1,2,
  5. Martin Krakauer3,4,
  6. Klaus Bønnelykke1,
  7. Hans Bisgaard1
  1. 1 Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
  2. 2 Department of Pediatrics, Næstved Hospital, Næstved, Denmark
  3. 3 Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Gentofte, Denmark
  4. 4 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  1. Correspondence to Professor Hans Bisgaard, Copenhagen Prospective Studies on Asthma in Childhood, DK-2820 Gentofte, Denmark; bisgaard{at}copsac.com

Abstract

Background Infants and young children might be particularly susceptible to the potential side effects from inhaled corticosteroid (ICS) on height and bone mineral content (BMC), but this has rarely been studied in long-term prospective studies.

Methods Children from two Copenhagen Prospective Studies on Asthma in Childhood cohorts were included. ICS use was registered prospectively from birth to age 6 and the cumulative dose was calculated. Primary outcomes were height and BMC from dual-energy X-ray absorptiometry (DXA) scans at age 6.

Results At age 6, a total of 930 children (84%) from the cohorts had a valid height measurement and 792 (71%) had a DXA scan. 291 children (31%) received a cumulated ICS dose equivalent to or above 10 weeks of standard treatment before age 6. We found an inverse association between ICS use and height, −0.26 cm (95% CI: −0.45 to −0.07) per 1 year standard treatment from 0 to 6 years of age, p=0.006. This effect was mainly driven by children with ongoing treatment between age 5 and 6 years (−0.31 cm (95% CI: −0.52 to −0.1), p=0.004), while there was no significant association in children who stopped treatment at least 1 year before age 6 (−0.09 cm (95% CI: −0.46 to 0.28), p=0.64). There was no association between ICS use and BMC at age 6.

Conclusions ICS use in early childhood was associated with reduced height at age 6 years but only in children with continued treatment in the sixth year of life.

  • paediatric asthma
  • asthma epidemiology
  • asthma pharmacology
  • clinical epidemiology
  • respiratory measurement

Data availability statement

Data are available upon reasonable request. Data that supports the findings in this study are available from the corresponding author upon reasonable request: participant-level personally identifiable data are protected under the Danish Data Protection Act and European Regulation 2016/679 of the European Parliament and of the Council (GDPR) that prohibit distribution even in pseudo-anonymised form, but can be made available under a data transfer agreement as a collaboration effort.

https://doi.org/10.1136/thoraxjnl-2020-216755

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    Data availability statement

    Data are available upon reasonable request. Data that supports the findings in this study are available from the corresponding author upon reasonable request: participant-level personally identifiable data are protected under the Danish Data Protection Act and European Regulation 2016/679 of the European Parliament and of the Council (GDPR) that prohibit distribution even in pseudo-anonymised form, but can be made available under a data transfer agreement as a collaboration effort.

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    Footnotes

    • KB and HB contributed equally.

    • Contributors The guarantor of the study is HB, from conception and design, to the conduct of the study and acquisition of data, data analysis, and the interpretation of the data. KB contributed to design of the study and interpretation of data. AK has written the first draft of the manuscript. AS supervised and contributed to the statistical analyses. All co-authors have provided important intellectual input and contributed considerably to the analyses and interpretation of the data. The corresponding author had full access to the data and had final responsibility for the decision to submit for publication. No honorarium, grant, or other form of payment was given to any of the authors to produce this manuscript.

    • Funding All funding received by COPSAC is listed on www.copsac.com. The Lundbeck Foundation (Grant no R16-A1694); The Ministry of Health (Grant no 903516); Danish Council for Strategic Research (Grant no 0603-00280B) and The Capital Region Research Foundation have provided core support to the COPSAC research center.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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