Inhaled Steroids Don't Affect Children's Growth in the Long Run
Oct. 11, 2000 -- Parents may breathe a little easier now when it comes to giving their asthmatic children corticosteroids.
While these are effective medications, worrisome research has suggested that children who use these drugs may not grow properly. But two new studies in this week's New England Journal of Medicine suggest that long-term use of inhaled corticosteroids does not keep asthmatic children from reaching a normal adult height.
"The take-home message is that the concern outweighs the risk," says study author Stanley Szefler, MD. Concern about the adverse effects of medications is one of the reasons asthma tends to be undertreated. Szefler is director of the Division of Clinical Pharmacology and of Pediatric Clinical Trials Center at the National Jewish Research and Medical Center in Denver.
Corticosteroids are potent drugs used to reduce inflammation and should not be confused with anabolic steroids, which are occasionally used illegally by athletes. Corticosteroids are used to treat asthma in both adults and children and work by reducing irritation and swelling in the airways. This, in turn, helps a person breathe easier. Asthmatics usually use corticosteroids in an inhaled form, which delivers the drug directly to the lungs.
Research, though, has shown that using this type of medicine may slow a child's growth. In fact, the FDA requires companies that manufacture these drugs to put this information on the drugs' labels, to alert health care providers. But thus far, it has been unclear whether the slowed growth rate might be permanent, or if an affected child will eventually reach his or her normal adult height.
The first study, done by researchers from several medical centers and led by Szefler, compared a corticosteroid, Pulmicort, with Tilade, which is another, nonsteroidal type of asthma drug. The researchers also evaluated the effects of Pulmicort on the children's growth.
More than 1,000 children who had mild to moderate asthma were randomly divided into three groups. One group was treated with Pulmicort, the second group got Tilade, and the third was given a placebo, or dummy pill. All of the children, who ranged in age from 5 to 12 years old, also used another drug called Proventil when they developed acute asthma symptoms.
The researchers found that neither drug was better than the placebo in helping overall lung function, but that the corticosteroid, Pulmicort, helped the children to control their asthma better. They had fewer hospitalizations and fewer urgent visits to their doctors. Pulmicort also reduced their need for other asthma medications.
When evaluating growth rates, the researchers found only a very slight difference in the children who were using Pulmicort. The slower growth rate occurred mostly within the first year that they used the drug. At the end of the study, which lasted from four to six years, the three groups all had similar growth rates.