Pemberian Kortikosteroid jangka pendek berulang dapat menimbulkan Ostopenia pada Anak-anak

Pemberian jangka panjang, penggunaan terus menerus kortikosteroid inhalasi sedikit lebih baik daripada pemberian jangka pendek berulang kortikosteroid oral karena dapat mengurangi pertumbahan mineral tulang dan menyebabkan osteopenia pada anak dengan asma persisten, terutama pada anak laki-laki, menurut artikel pada Pediatrik (jurnal) tajuk bulan Juli.

Penelitian sebelumnya telah mendokumentasikan efek kortikesteroid oral dan inhalan pada densitas mineral tulang pada orang dewasa, tetapi sedikit yang diketahui konsekuensi penggunaannya pada anak-anak, menurut Dr. H. William Kelly dkk.

Dr. Kelly dari University of New Mexico di Alburqueque, dan group beliau yang diikuti oleh 531 anak laki-laki dan 346 anak perempuan (usia antara 5-12 tahun, nilai tengah usia 16.6 thn saat terakhir follow up) yang menikuti prospective “Childhood Asthma Management Program”. Kortikosteroid oral diberikan dalam pemberian standar hingga 60 mg/hari selama 2 hari dan dilanjutkan hingga 30 mg selama 2 hari.

Peneliti mengamati efek dosis dependent kortikosteroid oral meledak pada pertambahan mineral tulang (p = 0.0002 for trend) dan hubungan peningkatan resiko oesteopenia (p = 0.02 for trend)di spina lumbal pada anak laki-laki.

Kostikosteroid inhalan juga berkaitan dengan pengurangan pertumbuhan mineral tulang pada anak laki-laki (p = 0.05 for trend), dan tidak menunjukkan dosis dependen ataupun berkaitan dengan resiko osteopenia.

Tidak ada hubungan yang signifikan antara kortikosteroid inhalan atau oral dengan pertumbuhan mineral tulang ataupun resiko osteopenia pada anak perempuan. Pengarang berspekulasi bahwa jumlah anak perempuan (yg mjd sampel, ed) dan efek protektif estrogen selama pubertas yang menjaga mereka dari terdeteksinya efek yang signifikan.

Pada kesimpulannya, Dr.Kelly dkk menuliskan ” Penggunaan kortikosteroid inhalan potensial mengurangi pertumbuhan mineral tulang pada anak laki-laki dan semakin bertambah selama masa pubertas, tetapi resiko ini lebih banyak keuntungannya daripada kerugiannya melihat kemampuannya mengurangi jumlah penggunaan kortikosteroid oral pada anak-anak ini”

Tulisan asli bisa di lihat disini :

http://www.medscape.com/viewarticle/578375?src=mp&spon=13&uac=78

Multiple Short Courses of Oral Corticosteroids May Cause Osteopenia in Children

NEW YORK (Reuters Health) Jul 31 - Long-term, sustained use of inhaled corticosteroids is less likely than multiple short courses of oral corticosteroids to reduce bone mineral accretion and cause osteopenia in children with persistent asthma, particularly in boys, according to an article in the July issue of Pediatrics.

Previous research has documented the adverse effects of both oral and inhaled corticosteroids on bone mineral density in adults, but little is known about consequences of their use in children, Dr. H. William Kelly and colleagues note.

Dr. Kelly, at the University of New Mexico in Albuquerque, and his group followed 531 boys and 346 girls (ages 5-12 years at baseline, median age 16.6 years at last follow-up) enrolled in the prospective Childhood Asthma Management Program. Oral corticosteroids were administered in standard courses of up to 60 mg/day for 2 days, followed by up to 30 mg for 2 days.

The investigators observed a dosage-dependent effect of oral corticosteroid bursts on bone mineral accretion (p = 0.0002 for trend) and an associated increased risk for osteopenia (p = 0.02 for trend) in the lumbar spine of boys.

Inhaled corticosteroids were also associated with a small reduction in bone mineral accretion in boys (p = 0.05 for trend), which did not appear to be dosage dependent or associated with osteopenia risk.

There were no significant associations between oral or inhaled corticosteroids and bone mineral accretion or risk of osteopenia in girls. The authors speculate that the smaller number of girls and the protective effects of estrogen during puberty kept them from detecting any significant effects.

In conclusion, Dr. Kelly and his associates write, "Inhaled corticosteroid use has the potential for reducing bone mineral accretion in male children progressing through puberty, but this risk is likely to be outweighed by the ability to reduce the amount of oral corticosteroids used in these children."

Pediatrics 2008;122:e53-e61.

RINITIS SERING KALI DIBARENGI ASMA YANG SULIT DIKONTROL

REUTERS HEALTH INFORMATION

News Author: David Douglas
CME Author: Charles Vega, MD

2 Mei 2008
Pasien penderita asma dengan respon jelek terhadap terapi asma biasanya juga menderita rinitis sedang hingga berat, para peneliti dari Brazil mengemukakan issue ini pada Journal Allergi bulan Mei.

Sebagai seorang peneliti senor, Dr Alvaro A. Cruz menyampaikan pada Reuter Health , " artikel ini melaporkan adanya hubungan yang kuat antara rinitis sedang-berat dengan asma tidak terkontrol."

Dr. Cruz, dari Universidade Federal de Bahia dan rekan rekan juka menyatakan bahwa asma dan rhinitis memiliki beberapa kesamaan dan prevalensi rinitis cukup tinggi pada penderita asma.

Untuk meneliti lebih lanjut hubungan antara tiap kondisi, para peneliti melakukan studi prospectif pada sebanyak 557 penderita asma berat. Dari kesemuanya, 31% menderita rhinitis sedang-berat, 54% menderita rhinitis ringan dan 15% tanpa rhinitis.

Dibandingkan dengan subyek yang lain, pasien dengan asma sedang berat mengalami lebih dari 3 kali ((odds ratio, 3.83) harus mendatangi ruang gawat darurat dalam setahun untuk pemeriksaan/ follow up.

Diakhir pemeriksaan, mereka juga mengalami 3 kali lipat (odds ratio, 2.94) menunjukkan perbaikan sumbatan jalan nafas kurang dari 10% dan lebih dari 12 kali memiliki asma yang tidak terkontrol.

Tim ini menunjukkan korelasi positif antara keparahan rhinitis dengan keparahan asma dan adanya korelasi negatif dengan skore quality-of-life.

" Menjadi suatu pertimbangan agar pasien mendapatkan terapi yang terbaik untuk asma dan rhinitis" kata Dr. Cruz pada kesimpulan. " Dari sekian banyaknya penjelasan dari pengamatan inter-relationship menyatakan bahwa keduanya (rhinitis dan asma) merupakan manifestasi penyakit yang sama dari keseluruhan jalan nafas, dengan derajat keparahan saluran nafas atas dan bawah yang saling berkorelasi."

Allergy. 2008;63:564-569.

Reuters Health Information 2008. © 2008 Reuters Ltd.

Rhinitis Often Accompanies Hard-to-Control Asthma CME

News Author: David Douglas
CME Author: Charles Vega, MD
Disclosures

Release Date: May 2, 2008; Valid for credit through May 2, 2009

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians

To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.

Learning Objectives

Upon completion of this activity, participants will be able to:

1. Describe the relationship between asthma and rhinitis.
2. Identify the effects of rhinitis on measures of asthma control among patients with severe asthma.

Authors and Disclosures

David Douglas
Disclosure: David Douglas has disclosed no relevant financial relationships.

Charles Vega, MD
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.

Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

May 2, 2008 — Patients who have a poor response to asthma treatment are likely to also have moderate-to-severe rhinitis, Brazilian researchers report in the May issue of Allergy.

As senior investigator Dr. Alvaro A. Cruz told Reuters Health, "this article reports on strong evidence for an association between moderate-to-severe rhinitis and uncontrolled asthma."

Dr. Cruz, of Universidade Federal de Bahia, and colleagues also note that asthma and rhinitis share many similarities and the prevalence of rhinitis among asthmatics is high.

To further investigate the relationship between the conditions, the researchers prospectively studied 557 patients with severe asthma. In all, 31% had moderate to severe rhinitis, 54% had mild rhinitis and 15% had no rhinitis.

Compared to the other subjects, patients with moderate-to-severe rhinitis were more than 3 times as likely (odds ratio, 3.83) to visit the emergency room during a year of follow-up.

By the end of follow-up, they were also almost 3 times as likely (odds ratio, 2.94) to show a less than 10% improvement in airway obstruction and were more than 12 times as likely to have uncontrolled asthma.

The team found a positive correlation between the severity of rhinitis and severity of asthma, and a negative correlation with quality-of-life scores.

"Taking into consideration that the patients were receiving the best treatment options for asthma and rhinitis," Dr. Cruz said in conclusion, "the most likely explanation for the observed inter-relationship is that both rhinitis and asthma were manifestations of the same disease affecting the entire airway, for which the degree of severity of the upper and lower airway processes is correlated."

Allergy. 2008;63:564-569.

Reuters Health Information 2008. © 2008 Reuters Ltd.