Knemometric assessment of systemic activity of once daily intranasal dry‐powder budesonide in children

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Abstract
Systemic activity of the intranasal glucocorticosteroid budesonide administered once daily from a dry‐powder inhaler (Turbuhaler®) was assessed by knemometry. Lower leg length was measured weekly in 38 children aged 7–15 (mean 11.3) years with allergic or perennial rhinitis. The design was a randomized, double‐blind, parallel‐group study. After 4 weeks’ run‐in, the children were allocated to 4 weeks’ treatment with either budesonide 200 or 400 μg or placebo. Fourteen children in the budesonide 200‐μg group, 13 in the 400‐μg group, and 10 in the placebo group completed the study. In the placebo and budesonide 200‐μg groups, growth velocities during run‐in (0.36 and 0.28 mm/week, respectively) and treatment periods (0.34 and 0.27 mm/week, respectively) were almost identical. In the budesonide 400‐μg group (run‐in: 0.40 mm/week), a nonsignificant reduction in mean growth velocity of 0.18 mm/week was seen (P= 0.11). There were no statistically significant differences among the run‐in mean lower leg growth velocities (F= 1.12; P= 0.34), among growth velocities during treatment (F= 1.10; P= 0.34), or among the run‐in and treatment growth velocities in the three groups (F= 1.19; P= 0.32). These results provide good evidence that systemic activity is low in children with allergic or perennial rhinitis treated with once daily budesonide in doses of 200‐ and 400‐μg administered intranasally from a dry‐powder inhaler.