Objective: To observe the systemic side effects of low dose inhaled Beclomethasone dipropionate (BDP) in children with mild asthma.
Methods: 30 children with mild asthma were randomly divided into 3 groups to receive treatment with inhaled placebo (group A), BDP 200 micrograms/d (group B) and BDP 400 micrograms/d (group C) respectively. Bronchial hyperresponsiveness (BHR), height growth, bone mineral density (BMD), calcium and phosphate metabolism and hypothalamic-pituitary-adrenal axis (HPAA) function were measured.
Results: Inhaled BDP of 200 micrograms/d and 400 micrograms/d reduced BHR in mild asthmatic children and there was no significant difference between two groups [log(PD20-FEV1)]:(2.04 +/- 0.47) micrograms to (2.70 +/- 0.13) micrograms in group A and (1.94 +/- 0.46) micrograms to (3.15 +/- 0.18) micrograms in group B (P < 0.01). Serum osteocalcin, calcium, phosphate, alkaline phosphatase, basic cortisol and BMD didn't change significantly after BDP treatment in three groups (all P > 0.05) [In group A, B and C, concentrations serum osteocalcin were (29 +/- 12) micrograms/L, (22 +/- 6) micrograms/L, (31 +/- 11) micrograms/L, serum calcium: (2.49 +/- 0.11) mmol/L, (2.39 +/- 0.28) mmol/L, (2.20 +/- 0.35) mmol/L, serum phosphate: (1.8 +/- 0.6) mmol/L, (1.7 +/- 0.7) mmol/L, (1.5 +/- 0.4) mmol/L, radius BMD: (0.44 +/- 0.02) g/cm2, (0.42 +/- 0.05) g/cm2, (0.40 +/- 0.10) g/cm2, ulna BMD:(0.35 +/- 0.04) g/cm2, (0.36 +/- 0.08) g/cm2, (0.32 +/- 0.07) g/cm2, serum alkaline phosphatase: (410 +/- 113) U/L, (337 +/- 99) U/L, (351 +/- 122) U/L, serum basic cortisol: (350 +/- 86) nmol/L, (407 +/- 199) nmol/L, (365 +/- 71) nmol/L, lumbar spine (L4-5) BMD: (0.64 +/- 0.06) g/cm2, (0.59 +/- 0.08) g/cm2, (0.62 +/- 0.09) g/cm2 respectively]. Height growth had a trend of reducing after BDP treatment though not reaching statistical difference. Height standard deviation score (SDS): 1.1 +/- 0.7 to 1.2 +/- 0.9 in group A, 1.3 +/- 0.7 to 1.3 +/- 0.9 in group B and 1.1 +/- 0.7 to 1.0 +/- 0.7 in group C. Serum cortisol after ACTH stimulation reduced significantly in group C [(621 +/- 199) nmol/L to (482 +/- 97) nmol/L, P < 0.01].
Conclusion: The results of this study suggest that 200 micrograms/d BDP can reduce BHR significantly and has no detected systemic side effects in mild asthmatic children, and 400 micrograms/d BDP can reduce serum cortisol after ACTH stimulation. The long-term dose of BDP should be controlled to be less than 400 micrograms/d in children with mild asthma.