Reassurance over the effects on growth of long-term use of inhaled corticosteroids
has been provided by two studies.
In the first, Dr Lone Agertoft and Dr Søren Pedersen (department of paediatrics,
University of Southern Denmark and Kolding hospital) conclude that children
using inhaled budesonide attain normal adult height. They compared the effects
of long-term treatment with budesonide on growth in 142 children with asthma
with 69 controls (including 51 healthy siblings of patients in the budesonide
group). The children were followed for 10 years.
The researchers found that the budesonide-treated children reached their target
adult height to the same extent as their healthy siblings and the remaining
control group. The mean average daily dose of budesonide received was 412µg
and asthma was well controlled.
They note that budesonide treatment was associated with an initial phase of
growth retardation which was more pronounced in children of a younger age. However,
this retardation did not persist and adult height was not adversely affected.
They point out that previous studies had examined the effects of inhaled corticosteroids
in the short-term only (for up to one year) and that their study gave similar
results for the first year of treatment (New England Journal of Medicine 2000;343:1064).
In the second study, the US childhood asthma management program research group
concluded that the side effects of budesonide were limited to a small transient
reduction in growth velocity. In a study of 1,041 children, the effects of budesonide
were compared with those of nedocromil and placebo over a four to six year period.
The researchers found a difference in growth rate between the budesonide and
placebo groups in the first year but by the end of the study all groups had
similar growth veolicity. Growth extrapolations from one-year studies were not
appropriate, they comment. The study also showed that neither budesonide nor
nedocromil was better than placebo in terms of lung function measured by forced
expiratory volume but that budesonide improved airway responsiveness and provided
better control of asthma (ibid, p1054).
In an accompanying editorial, Dr Mary Wohl and Dr Jospeh Majzoub (children’s
hospital, Boston, United States) caution that while the skeletal growth results
were reassuring, they might not apply to growth of other organs. There was particular
concern over the effects of corticosteroids on lung development and until more
was known, they suggest it might be prudent to avoid the use of inhaled corticosteroids
in young children with very mild asthma (ibid, p1113).