Asthma and lower airway diseaseCorticosteroid use and bone mineral accretion in children with asthma: Effect modification by vitamin D
Section snippets
Study population
The demographics of the subjects enrolled in CAMP and the study design have been described previously.11 Briefly, 1041 children with mild-to-moderate asthma aged 5 to 12 years were randomized to budesonide, nedocromil, or placebo. This was a multicenter trial designed to evaluate the long-term effects of these treatments on lung growth. Follow-up visits occurred at 2 and 4 months after randomization and every 4 months thereafter. The children’s parents or guardians provided informed consent,
Patients’ demographics
From the 7 eligible study centers, a total of 780 subjects had a baseline vitamin D level and BMD measurement at baseline and at 4 years’ follow-up. The subjects lost to follow-up had a lower body mass index (BMI) and higher vitamin D level compared with the study participants, but other demographics did not differ significantly, including the percentage of randomization to budesonide (see Table E1 in this article’s Online Repository at www.jacionline.org). The median vitamin D level was
Discussion
In this evaluation of the combined effects of vitamin D level and corticosteroid use on BMA and BMD in children with asthma, we found a dose-dependent effect of OCS use on BMA in boys that was significantly modified by serum 25(OH)2D levels. Specifically, boys with lower vitamin D levels (≤30 ng/mL) had a doubling of the decrease in BMA after exposure to a moderate-to-high number of OCS treatment courses for asthma exacerbations (Fig 1). This effect was most notable in subjects taking the
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Cited by (0)
The Childhood Asthma Management Program is supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. Additional support for this research came from grants P50 HL67664, T32 HL07427, and R21 HL089842 from the National Institutes of Health and the National Heart, Lung, and Blood Institute. This article is subject to the National Institutes of Health’s Public Access Policy (http://publicaccess.nih.gov).
Disclosure of potential conflict of interest: H. W. Kelly is on the GlaxoSmithKline Steering Committee for FDA-mandated LABA safety study in children and the AstraZeneca, Novartis, and Merck Steering Committees for FDA-mandated LABA safety trials in adults. A. Litonjua has received research support from the National Institutes of Health (NIH) and receives author royalties from UpToDate, Inc. K. Tantisira has received research support from the NIH. The rest of the authors declare that they have no relevant conflicts of interest.