Hundreds of thousands of children with asthma use corticosteroid inhalers to help them breathe, but according to a new study from Brazil the medications commonly found in those inhalers may suppress growth. The scientific review, which systematically looked at previous research, was published in The Cochrane Library journal. Lead author Linjie Zhang, of Federal University of Rio Grande in Brazil, said that the evidence they looked at suggested that children who received daily inhaled corticosteroid treatment may grow about one-half centimeter (.2 inches) less during the first year of treatment than non-medicated children. The study looked only at the first year of the children’s treatment by inhaled medication.
The first review looked at data from 25 trials involving 8,471 children up to the age of 18 who had mild to moderate persistent asthma. Only 14 of the trials reported growth rates, which were on average 6-9 centimeters per year (2.4-3.5 inches) in the control groups. Children who regularly used corticosteroid inhalers grew .5 centimeters less on average during the first year of corticosteroid use. The researchers found that the growth suppression is less pronounced in subsequent years than during the first year.
The second review focused on 22 previous trials in which the children were treated with low to medium doses of the inhaled medication. Only three of those trials followed the children for a year or more, and the reviewers found that in the 728 children covered in those surveys, reducing the inhaled medication by about one puff per day was effective in improving growth rate by about .25 centimeter in one year.
Asthma is a common chronic ailment in children in which the body’s airways swell, preventing the lungs from filling with air. Corticosteroids are anti-inflammatory medication that can be inhaled and delivered directly to the person’s respiratory system to reduce the inflamed tissues and allow breathing to resume. Prescribed as first-line treatments for both adults and children with persistent asthma, inhaled corticosteroids are the most effective drugs at this time for controlling the disease and reducing hospital visits and deaths.
Seven inhaled corticosteroid drugs are currently available and the reviewed trials looked at all of them except for flunisolide and triamcinolone. The reviewers found that growth suppression varied across the studies, so they looked at other factors that might be involved in the effect on growth in children with asthma who use corticosteroid inhalers. Some of the variation could be explained by the different drugs used, but Zhang acknowledged that conclusions about which drug was better at minimizing the effect on growth rates needed to be confirmed by further studies that examined that specifically. He says only 14 percent of the trials monitored growth systematically for over a year.
Study co-author Francine Ducharme, from the Department of Pediatrics at the University of Montreal, said this important topic is a “major concern,” and recommends using the minimum effective dose of the medication until further data is available. The researchers agree that more long-term trials that compare different doses and different drugs over the long term are needed.
Since the growth suppression effects can be minimized by using lower doses of corticosteroids, the reviewers recommend using the lowest possible dosage to control a child’s asthma. Zhang said that the growth-stunting found in the study was minor compared to the benefit of the drugs.
By Beth A. Balen