Asthma is a serious global health problem that starts in childhood.
In most cases, inhaled drug therapy is advised which has to be taken lifelong. Inhaled corticosteroid therapy is considered to be the most effective and preferred first-line asthma treatment for long term control in children since it reduces asthma deaths, number of episodes, severity of exacerbations, and improve quality of life.
AdvertisementFurther, inhaled corticosteroids (ICS) are preferred over oral corticosteroids because of their local effect on the airways.
However, a recent review study published in The Cochrane Library indicated that growth of children slowed in the first year of treatment using inhaled corticosteroid drugs. But, the effects were minimized by using lower doses.
'The evidence we reviewed suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimetre less during the first year of treatment,' said lead author of the review, Linjie Zhang, Federal University of Rio Grande, Brazil.
'But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma and ensuring full lung growth,' she added.
Asthma drugs list
The following inhaled corticosteroid drugs are currently approved by the FDA for the treatment of asthma in adults and children -
Of these, ciclesonide, fluticasone and mometasone are newer and are considered to be safer drugs.
Budesonide is the only inhaled corticosteroid approved for use in children younger than 4 years of age.
No inhaled corticosteroids are approved by the FDA for children younger than 1 year of age.
Following is the comprehensive list of FDA-approved asthma drugs that do not use chlorofluorocarbon (CFC). CFC was used as a propellant in the inhalers, but is now being replaced due to its damaging effect on the atmosphere.
Tudorza Pressair (aclidinium bromide)
Proventil HFA, Ventolin HFA, ProAir HFA - (albuterol sulfate)
Combivent Respimat (albuterol sulfate and ipratropium bromide)
Duoneb (albuterol sulfate and ipratropium bromide)
Brovana (arformoterol tartrate)
QVAR (beclomethasone dipropionate)
Pulmicort Turbohaler, Pulmicort Flexhaler (budesonide)
Symbicort (budesonide and formoterol fumarate)
Breo Ellipta (fluticasone furoate and vilanterol trifenatate)
Flovent HFA (fluticasone propionate HFA)
Flovent Diskus (fluticasone propionate)
Foradil Aerolizer (formoterol fumarate)
Perforomist (formoterol fumarate)
Arcapta Neohaler (indacaterol)
Atrovent HFA (ipratropium bromide HFA)
Xopenex (levalbuterol sulfate HFA)
Asmanex Twisthaler (mometasone furoate)
Dulera (mometasone furoate and formoterol fumarate)
Serevent Diskus (salmeterol xinafoate)
ADVAIR Diskus (salmeterol xinafoate/fluticasone propionate)
ADVAIR HFA (salmeterol xinafoate/fluticasone propionate)
Spiriva Handihaler (tiotropium bromide)
Asthma drug side effects
Despite their effectiveness, asthma drugs come with their share of side effects, especially if the drugs are in the form of steroid tablets.
Side effects of steroid tablets include -
Suppression of the adrenal glands
Cataract and glaucoma
Tendency towards high blood pressure and diabetes
Mood changes and forgetfulness
Inhaled corticosteroids, on the other hand, have minimal side effects. This is because only a miniscule amount of the drug enters the bloodstream. So, they are safe at low doses.
High doses of inhaled corticosteroids can cause side effects which include -
Thrush: It is a yeast infection that occurs in the mouth. Rinsing the mouth or using a spacer with metered dose inhalers (MDI) prevents thrush.
Predisposition to cataracts and glaucoma
Thinning of bones
Bones in children are sensitive to even small amounts of corticosteroids that can enter the bloodstream after inhalation. So, long term use of these steroids may slow bone growth, and children may not reach their potential height. However, as the review studies point out, the effect is quite small and is less pronounced after first year of use.
Not giving inhaled corticosteroids to children for fear of growth suppression (only half a centimeter in the first year and less in subsequent years) can have far worse consequences in the form of severe asthma attacks and associated problems.