Glucocorticoids are anti-inflammatory medications
that help to prevent recurrent attacks of asthma. They help to prevent
recurrent attacks. Oral glucocorticoids
used in children over prolonged durations are associated with a number of side
effects including growth retardation.
These have now been replaced with inhalation medications, which bring
about a local action on the lungs and avoid adverse effects on other parts of
the body to some extent.
Inhaled glucocorticoids have been found to reduce
growth velocity to some extent during the first few years of treatment. The growth velocity returns to normal
A study published in the New England Journal of Medicine
evaluated if this initial decrease
in growth velocity had any effect on the final adult height. This study was a part of a larger trial
evaluating the benefits and safety of some anti-asthma medications.
The 1041 children included in the study were between
the ages of 5 and 13 years and were suffering from mild-to-moderate
asthma. They were divided into three
groups. The first group received 200μg
of budesonide (a glucocorticoid) by inhalation twice daily, the second group
received 8mg of nedocromil by inhalation twice daily, and the third group
received placebo. The participants
received the medication for 4 to 6 years.
Salbutamol was used for asthma symptoms in all the three groups.
Height and weight was measured every 6 months during
the first four and a half years of study, followed by 1 to 2 times a year for
the next 8 years. Adult height was
measured in around 90% of the study subjects.
The mean adult height was found to be 1.2 cm lower
in the budesonide group as compared to the placebo group. A larger dose in the first 2 years of
treatment was also associated with a lower adult height. During the first 2 years of treatment,
height was mainly decreased in those subjects who had not reached puberty.
researchers thus found that the height deficit observed during the first 1 to 2
years after starting inhalational glucocorticoids persisted even in adulthood.
However, they also caution that the benefits of the drug should
be weighed against this side effect. A
lowest possible dose should be used to control asthma symptoms in children.
1. Effect of Inhaled Glucocorticoids in Childhood on Adult Height;
William Kelly et al; NEJM 2012