Some Asthma Medications May Slow Growth in Kids

Inhaled corticosteroids slowed growth in first year of use

(RxWiki News) Inhaled corticosteroids are an effective medication to bring down the airway swelling caused by asthma in children. Two new studies suggest that while these medicines may help children breathe, they also may have a negative effect.

These studies showed that children taking the inhaled corticosteroids grew about half a centimeter less in height than other children in a year.

"Ask a pharmacist about the possible side effects of your child's asthma medication."

The reviews were conducted separately by Linjie Zhang, associate professor at the Federal University of Rio Grande in Brazil, and Francine Ducharme, PhD, of the University of Montreal in Canada, and colleagues.

While the researchers found that children using inhaled corticosteroids had slightly slowed growth compared to other children during the first year of use, the effect was minimized in children who took lower doses.

Asthma is a chronic inflammatory disorder of the airways that leads to recurrent wheezing, breathlessness, chest tightening and coughing. It is caused by a combination of genetic and environmental factors. Inhaled corticosteroids can relieve asthma symptoms.

In the review conducted by Dr. Zhang and colleagues, the researchers looked at 25 trials with 8,471 children, 18 years old and younger, who had mild to moderate asthma.

The trials tested all the available inhaled corticosteroids except triamcinolone. Fourteen of the trials involved 5,717 children and looked at growth during one year. The children on inhalers were compared to children taking either non-steroidal medications or placebos (fake treatments not containing real medication).

Growth in children taking inhaled corticosteroids slowed by 0.48 centimeters per year compared to other children. The authors of this study noted some differences among the children based on individual susceptibility to the medicines.

The researchers found that growth suppression was not progressive or regressive beyond the first year of inhaled corticosteroid use and said that they did not know why growth was less affected after the first year of therapy.

Dr. Ducharme and colleagues reviewed data from 22 trials in which children were treated with low or medium doses of inhaled corticosteroids. These trials tested different doses of all corticosteroids except triamcinolone and flunisolide. Three trials followed 728 children for one year or longer.

Compared to children on lower doses of inhaled corticosteroids (50 to 100 micrograms), those on higher doses (200 micrograms) averaged a 0.2 centimeter lower growth in height annually, the researchers found.

Those children who needed one fewer puff per day had 0.25 centimeters more growth in a year than children who took one more puff of their inhaled corticosteroids daily, the researchers reported.

In a press release, Dr. Ducharme noted how few studies actually compared growth in children who took inhaled corticosteroids and said more studies are needed.

"We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available," she said. "Growth should be carefully documented in all children treated with inhaled corticosteroids, as well as in all future trials testing inhaled corticosteroids in children.”

In an interview with dailyRx News, Mark Millard, MD, a pulmonologist who serves as Medical Director of the Baylor Martha Foster Lung Care Center at Baylor University Medical Center at Dallas, explained how asthma medications are valuable to many children living with asthma.

"We are all concerned about any medication given on a regular basis to children, but as a whole, the information from clinical studies shows that controlling asthma with anti-inflammatory medication is both safe and effective," Dr. Millard said.

"When asthma symptoms are controlled, children can sleep through the night, play soccer or basketball without fear of going down with an asthma attack, and perhaps even get a perfect school attendance record. By withholding daily controller medications, parents risk their children having an asthma flare that would require by mouth or injection steroids which have a much more profound impact on growth and health," he said.

The reviews by Drs. Zhang and Ducharme were published in The Cochrane Library on July 17.

The researchers noted that the authors of many of the included studies cited conflicts of interest, including funding from pharmaceutical companies like AstraZeneca and Nycomed Pharma.

The researchers reported no funding conflicts, but Dr. Ducharme reported that she received travel support, research funds and speaking fees from GlaxoSmithKline, Novartis, Nycomed and/or Merck Frosst.

Review Date: 
July 16, 2014