Image: Budesonide, GNU FDL
Primer: Inhaled glucocorticoids, a key in the treatment of persistent asthma in children, are known to reduce growth velocity in a linear manner after treatment initiation. While the velocity returns to normal a few years after initiation of treatment, the effect of the period of decreased velocity on overall attainable adult height is unclear in the literature.
This study: Published today in the New England Journal of Medicine [NEJM], a new study measured adult height in 943 subjects of the Childhood Asthma Management Program trial at 25 years old. The subjects initially were randomized to receive budesonide (inhaled glucocorticoid), nedocromil (cromone – a mast cell stabilizer), or placebo daily for 4 to 6 years, beginning at ages 5-13. The primary outcome measured was differences in adult height for each group. The results were adjusted for demographic characteristics, asthma features, and height at trial entry.
The study found that mean adult height was 1.2cm lower in the budesonide group than in the placebo group (p=0.001). There was no difference in the nedocromil group vs. placebo. There was no difference in the effect of budesonide on adult height according to the age at trial entry, race or ethnic group, or duration of asthma at trial entry.
In addition, a larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height: −0.1 cm for each microgram per kilogram of body weight (p=0.007). Also notable is the finding that a longer time since asthma diagnosis at trial entry and atopy were shown to be independent risk factors for shorter adult height.
In sum: This analysis of a previous randomized trial adds, for the first time, knowledge that the reduction in growth during the initiation of inhaled glucocorticoids in prepubertal children persists as a reduced overall adult height. As always, the benefits of inhaled glucocorticoids must be weighed against the harms when educating patients and parents, and the lowest possible effective dose should always be used.
Click to read the study in the New England Journal of Medicine [NEJM].
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