Iles R, Williams R M, Deeb A, Ross-Russell R, Acerini C L
Department of Paediatrics, Addenbrooke's NHS Trust, Cambridge, UK.
Pediatr Pulmonol. 2008 Apr;43(4):354-9. doi: 10.1002/ppul.20770.
Fluticasone proprionate (FP) is increasingly used to treat very young children with asthma. Its safety in terms of effects on the hypothalamic pituitary axis (HPA) and growth in this age group is uncertain.
Eleven children (median (range) age 10 (5.6-24.3) months) presenting with recurrent wheeze and family history of asthma were studied prospectively for a period of 18 months. Children received daily-inhaled FP 250 microg via a spacer device. No other corticosteroid therapy was administered prior to or during the study. A Short Standard Synacthen Test (SST) (125 microg) was performed pretreatment, and after 6 and 18 months. Weight (Wt), height (Ht), and body mass index (BMI) were measured at 3-6 monthly intervals.
Fasting early morning and peak cortisol levels remained within the normal reference range with therapy. There were no changes in Ht SDS, whereas both Wt SDS (baseline 0.05 (-2.17 to 0.52) vs. +18 months 0.68 (-0.5 to 1.36) P < 0.02) and BMI SDS (-0.22 (-1.73 to 0.75) vs. 0.86 (0.03 to 1.99) P < 0.005) increased after 18 months of treatment.
Daily treatment with inhaled FP 250 microg in young children with asthma appears to have no adverse effects on the HPA or on linear growth, however, treatment is associated with increases in body Wt and BMI in young children.
丙酸氟替卡松（FP）越来越多地用于治疗哮喘幼儿。其对该年龄组下丘脑-垂体轴（HPA）及生长的安全性尚不确定。
前瞻性研究了11名年龄中位数（范围）为10（5.6 - 24.3）个月、有复发性喘息且有哮喘家族史的儿童，为期18个月。儿童通过储雾罐装置每日吸入250微克FP。研究前及研究期间未给予其他皮质类固醇治疗。在治疗前、6个月和18个月时进行短程标准促肾上腺皮质激素试验（SST）（125微克）。每3 - 6个月测量体重（Wt）、身高（Ht）和体重指数（BMI）。
治疗期间空腹清晨及皮质醇峰值水平保持在正常参考范围内。身高标准差评分（Ht SDS）无变化，而体重标准差评分（基线0.05（-2.17至0.52）对比18个月时+0.68（-0.5至1.36），P < 0.02）和体重指数标准差评分（-0.22（-1.73至0.75）对比0.86（0.03至1.99），P < 0.005）在治疗18个月后均升高。
对于哮喘幼儿，每日吸入250微克FP治疗似乎对HPA或线性生长无不良影响，然而，该治疗与幼儿体重和BMI增加有关。
