September 19, 2012

Children on Inhaled Steroids Come Up Short but Still
Benefit From Treatment

Vienna—Despite the longstanding belief that the effect was temporary, inhaled steroid drugs for asthma slightly affect adult height in children who use them regularly, according to a recent study.

The reduction in eventual height may be a small price to pay, however, for having well-controlled asthma, according to the study’s senior author.

“If a child is not growing as they should, we may reduce their steroid dose," said Robert C. Strunk, MD, the Donald Strominger Professor of Pediatrics at Washington University School of Medicine in St. Louis. "But we think that the half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimize concerns about effects on adult height."

The comprehensive asthma study, presented earlier this month at the European Respiratory Society meeting in Vienna, Austria, and published online in the New England Journal of Medicine, involved more than 1,000 children ages 5 to12 who were treated for mild-to-moderate asthma as part of the Childhood Asthma Management Program (CAMP) clinical trial.

The children, who received treatment for more than 4 years at eight centers, were divided into three groups: one received twice-daily budesonide; a second group received nedocromil; and a third group received a placebo. Albuterol and oral corticosteroids also were used as needed for the children’s asthma symptoms.

Adjusting for demographic characteristics, asthma features, and height at trial entry, researchers tracked 943 of the trial participants until they reached adult height. Females were considered to be at adult height at age 18 or older and males at age 20 or older. Patients' height and weight were recorded every 6 months in the first 4.5 years after the trial ended, with height and weight measured once or twice a year over the next 8 years.

Ultimately, mean adult height was about one-half inch shorter in the group that received budesonide than in the patients who received nedocromil or placebo. Slowest growth occurred primarily between 5 to 11 years of age when the patients began using budesonide, but they remained a half-inch shorter into adulthood.

"This was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height," Strunk said. "But none of those studies followed patients from the time they entered the study until they had reached adult height."

The height-limiting effect was seen across gender, ethnicity, severity of asthma, age at which the child entered the trial, and allergy issues, according to the study.

"We found it made no difference if they were boys or girls or how long they had had asthma, or any other of these factors," Strunk pointed out. "We also looked at the height of the parents, and that didn't have any impact, either."

The original CAMP trial, begun in the mid-1990s, showed that using budesonide twice daily led to fewer hospitalizations and urgent care visits, fewer days in which additional asthma medications were needed, and a reduced need for albuterol in children prescribed the inhaled steroids. Using nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms but did not affect the number of hospitalizations, symptoms, or airway responsiveness.

U.S. Pharmacist Social Connect