Inhaled Corticosteroids and Growth in Children

The next issue of Treatment Guidelines from The Medical Letter (August 2013), which reports on Drugs for Asthma and COPD, gives a new answer to an old question: Do inhaled corticosteroids used by children have any affect on their height as adults? Inhaled corticosteroids are the drugs of choice for children with persistent asthma. Low or medium doses of these drugs do not cause typical corticosteroid side effects, except that they have long been known to slow growth in the first year or two of use. The conventional interpretation of that slowing has been that there would be catch-up growth later on, and final adult height would not be affected.

But then some people (HW Kelly et al, New England Journal of Medicine, 2012; 367:904) took the time and trouble to do a long-term controlled trial, supported by the National Heart, Lung and Blood Institute of the National Institutes of Health. They randomly assigned more than 1000 children 5 to 13 years old with mild to moderate asthma to inhale the corticosteroid budesonide, nedocromil (another, less effective, type of anti-inflammatory drug) or a placebo for 4 to 6 years. After that, the children continued to be followed and adult height was measured at a mean age of 25 years. Mean adult height was lower in the patients randomized to budesonide by 1.2 cm in both sexes, 1.8 cm in women and 0.8 cm in men. The mean deficit in height at the end of the first 2 years of the active trial was 1.3 cm and at the end of the trial was 1.2 cm, which persisted into adulthood.

Hats off to the investigators for sticking to this difficult undertaking, which they began in 1993. So many questions in therapeutics require long-term trials like this one to get answers we can trust. A loss of 1 cm in height is probably a justifiable price to pay for the benefits of inhaled corticosteroids for children with asthma, but now at least we have reliable data that we can use to give parents the information they need to make decisions like that for themselves.

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Comments

  1. This has been a question debated for decades, not only with inhaled corticosteroids for asthma but also nasal steroids used in children with polyposis and refractory rhinosinusitis. Hats off to these researchers for carrying out what is needed more often–long-term research.

  2. Lynn Braunstein says:

    How ethical was it to withhold inhaled corticosteroids from a child with asthma?

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