Inhaled Corticosteroids May Cause Only Temporary Slowing of Growth in Children, Studies Suggest
In the 1990s, several studies suggested that inhaled corticosteroids suppress growth in children. However, it was not clear whether adult height was diminished, since those studies were only about one year in duration. Two studies published in October are reassuring in that they suggest that children who receive long-term inhaled corticosteroid therapy for asthma reach or are expected to reach a normal adult height. In both studies, the growth rate was reduced about 20% during the first year of inhaled budesonide therapy but recovered despite continued use of the inhaled corticosteroid.
In the study by Agertoft and Pedersen,1 budesonide-treated children were as likely as healthy siblings or a control group of asthma patients to reach their expected adult height. In all three groups, more than 95% of the children attained their expected adult height.
The control group consisted of 18 children whose parents declined to change their asthma therapy to include budesonide. The budesonide group included 142 children whose parents agreed to the change in therapy. Fifty-one healthy siblings participated in the study.
Among budesonide-treated patients, the growth rate during the first year of treatment averaged about 1 cm less than it did during the prior year. Over the second year of treatment, the growth rate was about 0.6 cm less than the prebudesonide rate. In year 3, the mean growth rate rebounded to within 0.2 cm of the prebudesonide rate.
The mean age at the start of budesonide therapy was 8.7 years (range, 313 years). The mean duration of budesonide treatment at the time of attainment of adult height was 9.2 years (range, 313 years), and the mean cumulative dose was 1.35 g.
Physical growth was a secondary outcome measure in the Childhood Asthma Management Program study, a randomized, placebo-controlled trial of inhaled corticosteroids or nedocromil for management of mild to moderate asthma.2 Some 1041 children participated in the study. Final adult height had to be estimated because the children were 5 to 12 years of age (average, 9.0 years) at the start of the study and they were followed for just four years.
Over the study period, the height of budesonide-treated patients increased an average of 22.7 cm while the heights of placebo- and nedocromil-treated patients increased 23.7 and 23.8 cm, respectively. Most of the 1.1-cm height difference between the budesonide and placebo groups occurred during the first year. At the study's end, neither the nedocromil nor the budesonide group differed from the placebo group in projected final height or Tanner stage of sexual development.
Several cautions were offered by editorialists Wohl and Majzoub.3 The Childhood Asthma Management Program Research Group did not report the pubertal status of children at the start of the study, and any differences among the groups could have influenced growth rates. Wohl and Majzoub also cautioned that the reassuring findings regarding skeletal growth might not apply to growth of the lungs, the brain, or other organs. In their view, until more is known about the effects of inhaled corticosteroids on organ growth and development, "it may be prudent to avoid the use of inhaled corticosteroids in young children with very mild asthma."
- Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med. 2000; 343:1064-9.
- The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000; 343:1054-63.
- Wohl MEB, Majzoub JA. Asthma, steroids, and growth. N Engl J Med. 2000; 343:1113-4. Editorial.