Reports from the Field: Inhaled steroids don’t stunt growth
Reports from the Field: Inhaled steroids don’t stunt growth
Two major studies in the New England Journal of Medicine confirm that long-term use of inhaled corticosteroids to treat childhood asthma offers significant benefits in terms of asthma control with no long-term impact on growth.
Both studies examined the long-term effects of using an inhaled corticosteroid to treat childhood asthma. A study by Danish researchers examined the effect of long-term treatment with inhaled corticosteroid budesonide treatment on final adult height. Researchers found that, after a mean of 9.2 years of budesonide treatment at a mean daily dose of 412 mcg, children reached their target adult height to the same extent as their healthy siblings and the children in the control groups. No significant correlation was found between the duration of treatment or the cumulative dose of budesonide and the difference between the measured and target adult heights.
The second study involved more than 1,000 children between ages 5 and 12 years who had asthma symptoms for a mean of five years. After following the children for four to six years, the American researchers not only confirmed the findings of their Danish peers but also concluded that an inhaled corticosteroid provided better asthma control than either placebo or nedocromil, a nonsteroidal anti-inflammatory.
Findings of this second study include:
• Compared with children in the placebo group, children taking the inhaled corticosteroid had a 43% lower rate of hospitalization, a 45% lower rate of visits for urgent care, and a 43% lower rate of prednisone use over the course of the treatment period.
• Children taking the inhaled corticosteroid had significantly fewer symptoms, used less albuterol, and had more days without asthma episodes.
• Children in the nedocromil and placebo treatment groups needed more belomethasone dipropionate and oral prednisone to keep their asthma under control.
• Children in the placebo group required additional medications on 18.7% of total treatment days.
• Children in the nedocromil group required additional medications on 17.1% of total treatment days.
• Children in the inhaled corticosteroid group only required additional medications on 6.6% of total treatment days.
• Children in the inhaled corticosteroid group experienced no decline in lung function over time, as did children in the other two groups.
"The results of these two studies reaffirm current guidelines regarding the use of inhaled corticosteroids as first-line maintenance treatment for children with persistent asthma," explains Martha White, MD, director of research at the Institute for Asthma and Allergy at the Washington Hospital Center in Washington, DC. "Inhaled corticosteroids are a key component of proper asthma management and have important benefits when used daily as a long-term preventive medication for persistent asthma, even mild persistent asthma."
[See: Agertoft L, Pederson S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med 2000; 343:1,064-1,069. See, also: The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000; 343:1,054-1,063.]
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