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Inhaled glucocorticoids—the recommended treatment for persistent childhood asthma— reduce growth velocity in prepubertal children during the first years of treatment, but it hasn't been clear whether they affected adult height. Now the results of a follow-up study of participants in the Childhood Asthma Management Program have shown that children treated with inhaled glucocorticoids for asthma may indeed be slightly shorter as adults than peers not treated with these agents. The well-established benefits of inhaled glucocorticoids in controlling persistent asthma must be balanced against the drugs' small but persistent effect on height, experts say.
In the study, 1,041 children five to 13 years of age with mild-to-moderate asthma were randomized to daily treatment with budesonide, an inhaled glucocorticoid; nedocromil, an inhaled nonsteroid medication; or placebo. Albuterol was used to control asthma symptoms in all three groups. The researchers followed 943 children until adulthood.
The mean adult height, measured at a mean of 25 years, was 1.2 cm lower in the budesonide group than in the placebo group, and the effect was dose dependent. In the nedocromil group, the mean adult height was comparable to that in the placebo group.
The slower growth in the budesonide group occurred during the first two years of treatment, primarily in prepubertal children.
The authors recommend that agents with higher therapeutic indexes be used at the lowest effective doses to minimize the possible effects on height.
Jodi Shroba, an NP at Children's Mercy Hospitals and Clinics in Kansas City, Missouri, said that the inhaled glucocorticoids are of great value in the treatment of childhood asthma but that “it's important to let parents know about the data so that we can openly discuss the risks and benefits of medication.”—Karen Rosenberg
Kelly HW, et al. N Engl J Med. 2012;367(10):904–12