Children taking steroids for asthma are slightly shorter than peers
Children who use inhaled steroid drugs for asthma end up slightly shorter at their full adult height than children who don't use the drugs, new results from a comprehensive asthma study show.
The findings will be presented Sept. 3 at the European Respiratory Society meeting in Vienna, Austria, and published online the same day in the New England Journal of Medicine. The study's senior author is Robert C. Strunk, MD, the Donald Strominger Professor of Pediatrics at Washington University School of Medicine in St. Louis.
The study involved more than 1,000 children ages 5-12 who were treated for mild to moderate asthma as part of the Childhood Asthma Management Program (CAMP) clinical trial. The children received treatment for more than four years at eight centers, including Washington University School of Medicine. They were divided into three groups: one received twice-daily budesonide, an inhaled corticosteroid medication; a second group received nedocromil, an inhaled non-steroid medication; and a third group received a placebo. All children received albuterol, a fast-acting drug for relief of acute asthma symptoms, and oral corticosteroids as needed for asthma symptoms.
The researchers followed 943 participants in the trial at regular intervals until they reached adult height. Females were considered to be at adult height at age 18 or older and males at age 20 or older, Strunk says. In the first 4 1/2 years after the end of the trial, researchers took patients' height and weight every six months. Over the next eight years, height and weight were measured once or twice a year.
The mean adult height was about one-half inch, or 1.2 centimeters, shorter in the group that received budesonide than in the patients who received nedocromil or placebo. The patients who experienced the slower growth were primarily between 5-11 years old when they began using budesonide.
The slower growth took place only in the first two years of the four-year study. As the study progressed, the children who took the budesonide remained one-half inch shorter through adulthood than the children who did not use the drug, says Strunk, who treats children with asthma at St. Louis Children's Hospital.
"This was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height," Strunk says. "But none of those studies followed patients from the time they entered the study until they had reached adult height."
Strunk, CAMP study chair, says researchers considered various factors that also might have contributed to the slower growth rate, including gender, age at the time the child entered the trial, how long the child had had asthma, as well as ethnicity, severity of asthma and reactivity to a skin test for allergies.
"We found it made no difference if they were boys or girls or how long they had had asthma, or any other of these factors," Strunk says. "We also looked at the height of the parents, and that didn't have any impact, either."
Pediatric asthma specialists at St. Louis Children's Hospital keep a close watch on the growth of their patients who use inhaled steroids, Strunk says. They are measured at every visit, and physicians keep a growth curve.
"If a child is not growing as they should, we may reduce their steroid dose," he says. "But we think that the half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimize concerns about effects on adult height."
Inhaled corticosteroids such as budesonide are the most effective form of anti-inflammatory treatment for asthma, which affects 9.4 percent of U.S. children. The drugs control symptoms and improve pulmonary function. Results from the original CAMP trial, begun in the mid-1990s, showed that using budesonide twice daily led to fewer hospitalizations and urgent care visits, fewer days in which additional asthma medications were needed and a reduced need for albuterol. Using nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms but did not affect the number of hospitalizations, symptoms or airway responsiveness.
More information: Kelly HW, Sternberg AL, Lescher R, Fuhlbrigge AL, Williams P, Zeiger RS, Raissy HH, Van Natta ML, Tonascia J, Strunk, RC. Effect of inhaled corticosteroids in childhood on adult height. New England Journal of Medicine, published online Sept. 3, in print Sept. 6, 2012.
Journal reference: New England Journal of Medicine
Provided by Washington University School of Medicine
- Asthma drugs need to be maintained for continued benefit Feb 17, 2009 | not rated yet | 0
- Daily wheezing treatment no different from intermittent in toddlers Nov 24, 2011 | not rated yet | 0
- Inhaled steroids may not be enough for some children with asthma May 22, 2007 | not rated yet | 0
- Vitamin D deficiency and poorer lung function in asthmatic children treated with steroids Jul 13, 2012 | not rated yet | 0
- 'Stepping up' asthma treatment in children leads to improvement Mar 02, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Indeterminism in Classical Physics
4 hours ago I was reading the Roger Penrose book Emperor's New Mind and he was explaining the determinism in Newtonian mechanics. He says that if we consider...
Current in two wires
4 hours ago Wire A and B, which have the same cross-sectional area are connected in series. There is a p.d. V across the whole wire. Suppose the two wires...
understanding the dipole model for Rayleigh scattering
6 hours ago Hello. I am currently studying scattering theory in detail for my BSc thesis, and I'm starting with Rayleigh scattering. I'm following Scattering...
question on coriolis effect with drag force
12 hours ago I really need help with this question. A small floating object initially moves with velocity v on the surface of a liquid at latitude λ. The...
Question of reflection and transmission of TEM wave in normal incidenc
18 hours ago Suppose TEM wave in +z normal to a boundary on xy plane at z=0. We know *E* & *H* are tangential to the boundary. Let ##\vec E_i=\hat x E##, be the...
the rudyak-krasnolutski effective potencial
18 hours ago Hi ... anyone now how to calculate or the formula of the rudyak-krasnolutski EFFECTIVE potencial ? the effective potencial includes the angular...
- More from Physics Forums - Classical Physics
More news stories
(Medical Xpress)—Scientists at Emory Vaccine Center have shown that an immune regulatory molecule called IL-21 is needed for long-lasting antibody responses in mice against viral infections.
Immunology May 23, 2013 | 5 / 5 (1) | 0 |
Human breastmilk responds quickly to protect the child when there is an infection in mothers or babies, according to new international research led by The University of Western Australia.
Immunology May 23, 2013 | 5 / 5 (1) | 0
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
Immunology May 20, 2013 | 4.8 / 5 (26) | 8 |
(Medical Xpress)—Scientists at King's College London have discovered that Vitamin D has the potential to significantly reduce the symptoms of asthma. The study, led by Professor Catherine Hawrylowicz from ...
Immunology May 20, 2013 | 5 / 5 (1) | 0 |
Saudi Arabia said Friday it would send samples taken from animals possibly infected with a deadly SARS-like virus to the United States for testing in a bid to find the source of disease.
57 minutes ago | not rated yet | 0
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
1 hour ago | 5 / 5 (2) | 0 |
New research presented today shows that formation of new neurons in the hippocampus - a brain region known for its importance in learning and remembering - could cause forgetting of old memories by causing a reorganization ...
1 hour ago | not rated yet | 0
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
1 hour ago | 3 / 5 (1) | 0
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
17 hours ago | 4.9 / 5 (7) | 0 |