Vitamin-D status and bone mineral density in asthmatic children on long-term inhaled corticosteroids

Abstract

Asthma is the most common chronic respiratory illness affecting children. Inhaled corticosteroids (ICS) form the main treatment modality in asthma. Reduction in bone mineral density (BMD) is an important adverse effect of steroid usage. This side effect is an established entity with oral corticosteroids but minimal with ICS therapy. However, there are reports regarding the detrimental effect of chronic therapy with ICS. Long-term high-dose budesonide more than 800 μg/day has been shown to reduce the BMD. However, this effect was not consistently seen with moderate doses of 400–800 μg/day. Anticipating the impact of steroids on bone metabolism and monitoring for it is essential. Annual monitoring of Vitamin-D levels and BMD in children on chronic therapy is beneficial for the early detection and management of steroid-induced osteopenia. Judicious ICS use at the lowest effective dose should be tailor-made for every individual.