SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
10/29/04
Short and intermediate growth effects of inhaled steroids in childhood asthmatics
Summary
Background - Several previous studies have found a modest decrease in the growth velocity (GV) of childhood asthmatic children treated with inhaled corticosteroids (ICS). However, some groups feel that such decreases in GV are transient with anticipated “catching up” to expected height in adolescence.
Findings - Wolthers and Heuck of the Children's Clinic in Randers, Denmark carried out sequential assessments of GV by knemometry and stadiometry in 16 asthmatic children (ages 6-13 years) treated with budesonide, an ICS, 200 mcg b.i.d. The GV pattern in these children was compared with that in 16 age-matched healthy children on no therapy.
They found that GV rates within each study group did not vary in short term observation (2-8 weeks) from that seen at 52 weeks. However, mean lower leg GV was consistently lower in the ICS treated asthmatics than in the healthy controls at all the sequential assessments through 52 weeks (p=0.02; p=0.03). Also the GV rate was significantly decreased at one year compared to baseline GV rates in the asthmatics, but not in the normals.
Conclusion - Short-term (2-8 weeks) effects on GV in ICS treated asthmatic children accurately reflect GV effects at one year.
Reference
Allergy 2004;59:1193-97
Editor's Comments
These findings in a relatively small study group suggest inhibition of GV rates at up to one year of ICS therapy in asthmatic children. However, 2 major limitations in the study preclude definitive conclusions about the findings in this study: 1) the control subjects in this study were healthy untreated children. It would have been far preferable to compare GV in age-matched persistent asthmatics (PA) not receiving ICS since PA itself may inhibit GV. It may be difficult to find such children with PA not receiving ICS. However, the preference by some parents for using n oral leukotriene antagonist (e.g. montelukast) instead of an ICS may allow such comparisons; 2) the findings after longer term use of ICS should have been described in view of findings reported by Pederson and others.
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