Inhaled steroids are commonly used to treat chronic asthma in adults and children. Ongoing concerns about the adverse effects of long-term corticosteroid treatment and conflicting data on corticosteroid use and linear growth in children led Agertoft and Pedersen to conduct a prospective study to track weight gain, total body growth, lung function and hospitalization in a cohort of children with chronic asthma. They recently reported data on growth rate in these patients as it relates to adult height.
Children who were enrolled had a diagnosis of asthma and no other underlying illnesses. They had to have been regular patients of the study clinic for at least one year and to have been seen at least every six months. After the run-in period, children whose asthma was acceptably controlled without the continuous use of inhaled steroids were switched to inhaled budesonide. Of the original 332 children who qualified, the families of 62 refused the change to budesonide. These children were maintained as the control group.
All children were seen at six-month intervals, when age, height, weight, lung function by spirometry, number of hospital admissions, medication history, such as use of beta2 agonists, and frequency and total dosing of budesonide were obtained. Children who took prednisolone for more than two weeks per year were excluded. The data analyzed for the study were collected from January 1986 through August 1999. The primary outcome was the measured adult height in relation to the target adult height. Secondary outcomes were the effect of the mean daily dose of budesonide on height, the total cumulative steroid dose and the duration of treatment. The study enrolled 270 children in the budesonide group; they had a mean age of 3.4 years at the time of entry. The children treated with inhaled budesonide attained their target adult height at the same rate as the children in the control group. In both groups, more than 95 percent of children reached an adult height that was within 9 cm above or below the target adult height.
The mean duration of treatment with budesonide was 9.2 years. The mean cumulative dose was 1.35 g, and the average daily dose was 412 μg. There was no significant association between measured and target adult height as it related to sex, age at beginning of budesonide treatment, age at which adult height was attained or duration of asthma before beginning budesonide treatment.
The authors conclude from their data that the use of inhaled budesonide did not prevent children from reaching their predicted adult height. Moreover, there was no direct association between dose or duration of treatment with this inhaled steroid and growth. They note that the results of this study are consistent with the findings of two smaller retrospective studies and one prospective study that addressed this issue.
editor's note: Data from this study should be reassuring to parents and clinicians who wish to treat their pediatric patients in accordance with the national guidelines but have on-going concerns about the effects of inhaled steroids.—j.t.k.