Madison, WI—When the condition of children with mild-to-moderate asthma deteriorates, physicians often temporarily increase the dosage of inhaled steroids. A new study finds that the practice not only fails to effectively prevent severe exacerbations but also could have the adverse effect of slowing growth.

The research published in the New England Journal of Medicine to coincide with presentation at a meeting of the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology and the World Allergy Organization in Orlando, Florida, points out that higher doses of inhaled steroids are routinely recommended when patients present with symptoms such as coughing, wheezing, and shortness of breath.

Yet, the University of Wisconsin School of Medicine–led study emphasizes that whether the approach was safe or effective in pediatric mild-to-moderate asthma had not previously been rigorously tested.

“These findings suggest that a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids,” explained study leader Daniel Jackson, MD, associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health in Madison. “Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children.”

For the study, conducted over nearly a year, researchers followed 254 children aged 5 to 11 years with mild-to-moderate asthma. While the children usually were treated with low-dose inhaled corticosteroids—two puffs from an inhaler twice daily—that changed when they began to show signs of asthma flare-up.

When participants experienced those events, which occurred multiple times during the study period in some of the children, researchers divided them into two groups—continuing low-dose inhaled steroids to half of the children while quintupling the dosage for the other half. The patients received inhaled steroids twice daily for 7 days during each episode.

The high-dose group received 14% more exposure to inhaled steroids than the low-dose group yet did not suffer fewer severe flare-ups. In fact, researchers determined that the number of asthma symptoms, the length of time until the first severe flare-up, and the use of rescue medication—i.e., albuterol—weren’t very different between the two groups.

The study also uncovered a surprising side effect: The rate of growth of children in the short-term high-dose treatment group was about 0.23 centimeters per year less than the rate for children in the low-dose treatment group. That occurred despite the short period of time the high-dose treatments were received—only about 2 weeks per year on average.

Study authors warn that children who used high-dose steroids more frequently or for longer periods of time could suffer even more dramatic effects on their growth. They also point out that the results were in line with previous studies showing growth rates affected by steroid usage.

“This study allows caregivers to make informed decisions about how to treat their young patients with asthma,” added James Kiley, PhD, director of the National Heart, Lung, and Blood Institute, which funded the study. “Trials like this can be used in the development of treatment guidelines for children with asthma."

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