A study found that the use of inhaled glucocorticoids in children results in a deficit in the final adult height.
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.
AdvertisementInhaled glucocorticoids have been found to reduce growth velocity to some extent during the first few years of treatment. The growth velocity returns to normal later.
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.
The 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