Two recent studies demonstrate that children with asthma who receive corticosteroids gain improved control over their asthma and grow to normal height. There has long been concern that steroids stunt growth in children.
In the first study, more than 1,000 children five to 12 years old were randomly assigned to receive 200 [mu]g budesonide (a corticosteroid), 8 mg nedocromil (a non-steroidal antiinflammatory agent), or a placebo twice daily, in addition to albuterol as needed.FIGURE
After a mean 4.3 years of follow-up, the children who received budesonide demonstrated a 43% reduction in both hospitalization and in the use of prednisone for an acute asthma episode; there was also a 45% reduction in visits for urgent care compared with the placebo group. The nedocromil group had better asthma control than did those in the placebo group but worse than those in the budesonide group did. Daily diaries indicated that the budesonide subjects had the fewest asthma symptoms, the least need to use albuterol, and the most episode-free days.
The mean increase in height at the end of the study was 1.1 cm lower in the budesonide group (22.7 cm) than in the placebo (23.8 cm) or nedocromil groups (23.7 cm). But the difference in the rate of growth was evident mostly in the first study year; thereafter, the rate of growth was comparable among all study subjects.
Another study followed children with asthma for a mean of 9.2 years to assess the relationship between steroid use and adult height. One hundred and forty-two children treated with budesonide achieved their targeted adult height (calculated from their parents' heights) at the same rates as did 51 healthy siblings and 18 control patients with asthma who didn't take budesonide. There was no relationship between height and daily dose of budesonide, cumulative dosage of budesonide, or number of years of taking budesonide. This study also found that patients receiving budesonide had lower growth rates in the first year on medication, but this did not affect their adult height.
The Childhood Asthma Management Program Research Group. N Engl J Med 2000;343(15):1054-63; Agertoft L, et al. N Engl J Med 2000;343(15):1064-9.