What Studies on Inhaled Corticosteroid Side Effects Used to SayThe most concerning side effect of inhaled corticosteroids in children is that the medications can affect vertical growth (height). Many studies on this subject show that older inhaled corticosteroids have a small effect on height in children — about 1 centimeter on average — during the first year or two of taking the medication. But this does not seem to get worse, even if the medication is continued long-term. Some small studies, however, suggest that children taking inhaled corticosteroids have a “catch-up” phase of increased or prolonged growth during the adolescent and teenage years, and that final adult height would not be affected.
A New Study on the Effects of Inhaled Corticosteroids on Adult HeightA study published in the New England Journal of Medicine in September 2012 showed that for at least one form of inhaled corticosteroid, budesonide, adult height was still lower in asthmatics who had taken an inhaled corticosteroid as a child. This study followed approximately 1,000 children (ages 5 to 13 years old) in the Childhood Asthma Management Program (CAMP) who had mild to moderate persistent asthma, and were treated with inhaled budesonide, nedocromil, or placebo for 4 to 6 years. These children were then followed to assess the effects of these medications on their growth until adulthood.
The results were somewhat surprising: the average adult height in the group that had taken budesonide was 1.2 centimeters (about a half-inch) shorter than that of the placebo group. These findings seem to contradict what asthma specialists have assumed for years: that there was no effect of inhaled corticosteroids on final adult height, and the major effect of asthma on adult height came from uncontrolled asthma — and/or the need for systemic corticosteroids, which are known to cause a wide array of significant side effects, including effects on growth.
Not All Inhaled Corticosteroids are Created EqualOlder inhaled corticosteroids, such as beclomethasone and budesonide, seem to have greater side effects on the body. This is mainly because the fraction of the older inhaled corticosteroid that's swallowed gets into the body, as opposed to newer inhaled corticosteroids, which are metabolized by the liver after being swallowed — and are therefore unable to cause as many side effects on the body. But even these newer inhaled corticosteroids, such as fluticasone, mometasone and ciclesonide, are absorbed into the body through the lungs, and can therefore still cause side effects on the body. There are no studies I'm aware of that show that these newer inhaled corticosteroids affect growth in children. In fact, studies on fluticasone and ciclesonide in asthmatic children who took the medicines for one year found no difference in growth rates when compared to children taking a placebo.
Asthma Treatment in Children: What to Do?Although this new information on the effect of inhaled budesonide on adult height is concerning, it shouldn’t change how aggressively asthma is treated in children. The effects of untreated (or undertreated) asthma in children is far more concerning than a small decrease in final adult height. Uncontrolled asthma also frequently results in emergency room visits, hospitalizations, missed school days, effects on sleep and activity, loss of lung function and, rarely, death. Newer inhaled corticosteroids would be preferable in children, although longer-term studies on these medications are needed to ensure that there truly is no effect on growth in children.
Kelly HW, et al. Effect of Inhaled Glucocorticoids in Children on Adult Height. NEJM. 2012;367(10):904-912.
Skoner DP, et al. Assessment of the Long-term Safety of Inhaled Ciclesonide on Growth in Children with Asthma. Pediatrics. 2008;121:e1-14.
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