Long-term usage inhaled budesonide may lower BMD in kids with Asthma

A new study revealed that long-term usage of medium to high-dose inhaled budesonide in asthmatic children was associated with decreased bone mineral density. The study was published in the Journal of Asthma. 

The most efficient anti-inflammatory medication and first-line treatment for asthma is inhaled corticosteroids (ICS). Long-term usage of ICS is usually required for the control of asthma. Higher doses may be needed in severe asthmatics. Systemic corticosteroids are known to cause osteoporosis. But there is uncertainty about the effect of inhaled corticosteroids on bone metabolism. Hence, researchers conducted a study to examine the impact of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma. 

A cross-sectional study was carried out in children aged 7–17 years with asthma, who received long-term (≥2 years), medium to high-dose inhaled budesonide (≥400μg/day in 6–11 years old; ≥800 μg/day in >11 years old). Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry and compared with reference Indian normative values. 

Key findings:

• Thirty-five children with moderate to severe asthma receiving long-term medium to high-dose inhaled budesonide, were included in the study.
• A significantly low lumbar-spine BMD was found in the study population compared to reference Indian values (p-value 0.002).
• Short stature was found in eight cases.
• Even after adjusting for height age in these short-stature instances, the study population's lumbar-spine BMD remained considerably low (p-value 0.020).
• There were no significant differences found in 25-hydroxy vitamin D levels between subjects with “low BMD” and “BMD z-score > –2”.  

Thus, the present study suggests that long-term medium to high-dose inhaled budesonide treatment in pediatric asthma decreases bone mineral density.  

TAKE-HOME MESSAGE

In this single-center cross-sectional study, researchers measured the bone mineral density (BMD) of asthmatic children aged 7 to 17 who had been receiving medium- to high-dose budesonide for at least two years. The 35 children receiving budesonide were found to have significantly lower lumbar–spine BMD compared with base reference values. 

Prior evaluations have not found a notable association between long-term inhaled corticosteroids and BMD but focused on low to medium doses. The current study signals that a larger evaluation may be warranted to comprehensively characterize the potential adverse effects, which, in turn, can inform patient counseling and practice guidelines.

Further reading: Sumanth H Patil. Effect of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma: a cross-sectional study. https://doi.org/10.1080/02770903.2023.2220815