Young adults who used inhaled steroid drugs to treat their asthma when they were children are slightly shorter - about half an inch - than those who didn't use the drugs, a new study finds.
Researchers followed 943 children, ages five to 12, who were treated for mild to moderate asthma for more than four years. The children were divided into three groups. One group took the inhaled corticosteroid medication budesonide (brand names Pulmicort, Rhinocort) twice a day; the second group took the inhaled non-steroid medication nedocromil (brand name Tilade); and the third group took a placebo.
All the children took albuterol, a fast-acting drug for relief of acute asthma symptoms, and oral corticosteroids as needed to treat asthma symptoms.
How the study was done
The children were followed until they reached their full adult height - age 18 or older for females and age 20 or older for males. The average height of patients who took budesonide was one-half inch shorter than those who took nedocromil or placebo. The slower growth occurred during the first two years of the study. As the study continued, the children who took budesonide remained one-half inch shorter than the other children until they reached their adult height.
"We found it made no difference if they were boys or girls or how long they had had asthma, or any other of these factors," study senior author Dr Robert Strunk, a professor of pediatrics at Washington University School of Medicine in St. Louis, said in a university news release. "We also looked at the height of the parents, and that didn't have any impact, either."
The study was presented at the European Respiratory Society meeting, in Vienna, and published online the same day in the New England Journal of Medicine.
Struck said asthma specialists at St. Louis Children's Hospital keep close tabs on the growth of patients who use inhaled steroids. The children are measured at every visit and doctors keep a growth curve.
What the study found
"If a child is not growing as they should, we may reduce their steroid dose," Strunk explained. "But we think that the half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimise concerns about effects on adult height."
Two other experts agreed that the slight decrease in height must be balanced against the benefits derived from the asthma medications.
"This is another example of the risks and benefits of a medical intervention," said Dr Kenneth Bromberg, chair of pediatrics at the Brooklyn Hospital Center, in New York City. "It should be noted that inhaled steroids decrease the need for oral steroids, which would likely have more of an effect on both growth and other factors such as cataracts, glucose tolerance and immune function. The alternatives, in terms of life quality, are clearly in the direction of the [inhaled steroids] intervention."
Dr Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, echoed those sentiments.
"The loss of height compared to expected height was not dramatic in this study," he said, and "without inhaled steroids, some of these persistent, asthmatic children may well have suffered considerable morbidity [illness], which was prevented by the inhaled steroids."
Horovitz added that "all drugs are double-edged swords, and it was almost impossible to control significant childhood asthma before the advent of inhaled steroids in the 1990s."
The American Academy of Allergy, Asthma and Immunology has more about childhood asthma.
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