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July 30, 2014
Inhaled Corticosteroids Affect Growth in Children
With Asthma Rio Grande, Brazil—Inhaled corticosteroid therapy for asthma slows growth in children initially, but the effect can be ameliorated somewhat by using lower doses, according to a pair of studies led by Brazilian researchers. The articles on inhaled corticosteroid drugs (ICS) and their effects on growth rates were published recently in The Cochrane Library. The report’s background information notes that ICS are prescribed as first-line treatments for adults and children with persistent asthma, and the drugs—beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, and triamcinolone—are the most effective available for controlling asthma and reducing asthma deaths and hospital visits as well as the number and severity of exacerbations. Yet, the potential effect of the drugs on the growth of children remains a concern for parents and clinicians, according to the authors. The first of the two reviews focused on 25 trials involving 8,471 children up to 18 years old with mild-to-moderate persistent asthma. Testing all available inhaled corticosteroids except triamcinolone, the trials indicate that, as a group, ICS suppressed growth rates when compared to placebos or nonsteroidal drugs. The average growth rate, which was around 6-9 cm per year in control groups, was reduced by about 0.5 cm in treatment groups. “The evidence we reviewed suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment,” said lead author Linjie Zhang, MD, PhD, of the Federal University of Rio Grande in Brazil. “But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma and ensuring full lung growth.” For the second review, a group including some of the same authors, reviewed data from 22 trials in which children were treated with low or medium doses of inhaled corticosteroids and found that using lower doses of inhaled corticosteroids, about one puff less per day, increased growth by a quarter of a centimeter after a year. Zhang cautioned, however, that “conclusions about the superiority of one drug over another should be confirmed by further trials that directly compare the drugs.” Francine Ducharme, MD, MSc, of the Department of Pediatrics at the University of Montreal in Canada was involved in both reviews and pointed out the need for more long-term trials as well as trials comparing different doses, especially for children with severe asthma who use higher doses of inhaled corticosteroids. “Only 14% of the trials we looked at monitored growth in a systematic way for over a year. This is a matter of major concern given the importance of this topic,” Ducharme said. “We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available. Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing inhaled corticosteroids in children.” |
U.S. Pharmacist Social Connect
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