الفهرس 
BRONCHIAL ASTHMAOnly 14 pages are availabe for public view
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Abstract
Asthma is the most common chronic disease of childhood, it is a worldwide problem that affects approximately 130 million people worldwide, and during the past several decades, this prevalence has been increasing by 5% to 6% per year reaching rates of 30% to 40% in many countries. So, it is important to assess accurately the impact of such a wide spread illness and its treatment regarding efficacy and safety.
Inhaled corticosteroids are recommended as first line anti-inflammatory therapy for the treatment of asthma. Inhaled corticosteroids have been used for the treatment of asthma in children for more than 20 yr. During this time, a substantial number of studies have been performed evaluating the safety and efficacy of this therapy. Generally, the results have been reassuring. Inhaled corticosteroids have a marked effect on both the immediate and the long-term aims of asthma therapy. Inhaled glucocorticosteroids are the most effective controller therapy, and are therefore the recommended treatment for asthma for children of all ages.
In this case control study we evaluated the long term effects of inhaled corticosteroids (ICS) e.g. budesonide and fluticasone propionate on growth, bone mineral density and (serum calcium, serum phosphorus & serum alkaline phosphatase) as indicators of bone formation.
The study sample was classified into three groups. Group I (20 asthmatic patients on ICS > 400 µg budesonide or equipotent for a period of one year at least), group II (20 asthmatic patients not receiving ICS), the two groups were selected from Ain Shams University, pediatric hospital, Pulmonology outpatient clinic, and group III (20 healthy children). Age range of all children was 5-13 years with no statistical difference in sex distribution.
All patients were subjected to Full history taking with special emphasis on (date of diagnosis, duration of illness, assessment of asthma severity, duration of treatment & dose of ICS and history of taking of oral corticosteroid), clinical examination with special emphasis on anthropometric measurements and chest examination. Investigations included Chest X ray, Tuberculin test, pulmonary function testing, X-ray left hand of patient for bone age. Biochemical markers of bone metabolism were done included (serum calcium, serum phosphorus, Serum alkaline phophatase enzyme), lastly assessment of bone mineral density by DEXA (Dual Energy x- ray absorptiometry) scans at (Lumbar spines at L2-L4 levels and neck of femur).
Our study found no statistically significant difference in anthropometric measurements and bone mineral density between the three studied groups; these results support the safety of ICS on growth and BMD.
No effect on growth or BMD was observed with treatment with dose > 400 µg budesonide or equipotent for a period of one year at least.
Also adequately controlled asthma disease does not affect metabolism or growth of asthmatic children. In contrast to systemic corticosteroids which cause many side effects including negative impact on growth and bone health especially if used for long term. Most studies including our study emphasize the safety of long term use of inhaled corticosteroids
In conclusion we observed that the use of inhaled steroids in high doses did not have any important impact on growth or BMD, its use in high doses we needed is a safe and effective treatment of bronchial asthma in Egyptian asthmatic children.