Inhaled Steroids Don't Affect Children's Growth in the Long Run
In the second study, Danish researchers Lone Agertoft, MD, and S?ren Pedersen, MD, DrMedSci, of the department of pediatrics at Kolding Hospital in Kolding, Denmark, evaluated the height of 200 adults who had used inhaled Pulmicort as children. Their findings were similar to those of the other study: While the medication affected growth initially, the effect was temporary and did not affect their adult height.
If a child has mild asthma with periodic episodes that require emergency care, hospitalization, or courses of oral steroids, says Szefler, then "there is a distinct possibility that these life-threatening episodes could be alleviated" by using an inhaled corticosteroid.
"Since there are children with very severe asthma who do require steroids, it is very reassuring that the growth rate -- while it goes down in the first year -- is not sustained," says Ira Finegold, MD. "These children are very sick and need their medication, so this may help relieve anxiety about [these medications]." Finegold, who was not involved in the study, is chief of allergy and immunology at St. Luke's-Roosevelt Hospital Center in New York.
But should all children with asthma, regardless of the severity of the disease, use these drugs? In an editorial accompanying the studies, Mary Ellen B. Wohl, MD, and Joseph A. Mazjoub, MD, both professors of pediatrics at Harvard Medical School, still recommend caution when using corticosteroids. One concern is that the steroids may affect the growth of other organs, such as the brain and the lungs.
Until more is known about the effects of these drugs on the body's other organs, they write, and "until better tools are developed to assess organ growth, it may be prudent to avoid the use of inhaled corticosteroids in young children with very mild asthma."
Bob Lanier, MD, who commented on the studies for WebMD, disagrees. He says that people do need to weigh the risks and benefits of corticosteroid therapy but that the health of children's lungs outweighs the possible risk of growth problems.
"Studies have demonstrated a loss of lung function of at least 1% a year in poorly managed asthma," he says. "I think parents should first be worried about the growth of lungs." Lanier is vice president of the American College of Allergy Asthma and Immunology.
But Finegold says that the editorialists' suggestions are valid. "When we're dealing with mild asthma, especially in very young children, I agree with the editorial that caution is warranted," he says. "In this population, alternate therapies should be assessed."
He points out that for an asthmatic child who also has allergies, for example, parents should consider allergy shots. "Allergy shots have no effect on growth and can decrease the severity of asthma," he says.
"The take-home message is that if your child has asthma, do not be afraid that inhaled steroids will give short stature," says Finegold. "Certainly for moderate to severe asthma, one should use the inhaled steroids without worrying that you're going to have short children."