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Potential Cumulative Steroid Burden In Paediatric Asthmatics
A DGReview of :"Burden of corticosteroids in children with asthma in primary care: retrospective observational study"
British Medical Journal (BMJ)
06/11/2002
By Elda Hauschildt
The potential cumulative steroid burden for paediatric asthma patients should be taken into consideration with prescriptions of both inhaled and nasal corticosteroids.
British researchers say the potential long-term toxicity of chronic corticosteroid use in children is unclear. "When more than one steroid preparation is prescribed, the total steroid burden should be calculated and consideration given to other treatment," suggest investigators from the University of Aberdeen.
Using computer data, the researchers identified the number of children treated in 185 Scottish general practices who were chronically prescribed both an inhaled and a nasal corticosteroid between November 1999 and October 2000.
All repeat prescriptions were identified for the two types of corticosteroid in three age groups: 0 to four years, five to 11 years and 12 to 16 years. The prescribed combined dose for each child was then calculated.
A total of 8,913 of 177,752 registered in the practices (5.1 percent) were chronically prescribed an inhaled steroid. Five hundred and sixty children (6.1 percent) also had a repeat prescription for a nasal corticosteroid.
It was found that the relative contributions of the two types of steroid preparations to total daily intake were similar across the three age groups. Nasal corticosteroids accounted for at least one-third of total daily intake.
The researchers suggest it is difficult to define low or high corticosteroid use. But they say a dose of beclomethasone up to 336 micrograms per day could be considered as low, 378 to 672 micrograms/d as moderate and above 672 micrograms/d as high.
Of the 560 children prescribed both types of steroid, between 341 (61 percent, minimum steroid dose used) and 462 (83 percent, maximum steroid dose used) were identified as having been prescribed enough to be in the chronic high-dose use range.
BMJ, 2002; 324: 1374-1375.
"Burden of corticosteroids in children with asthma in primary care: retrospective observational study"
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