This article is more than 5 years old. Information may no longer be current.
Inhaled glucocorticoid use in childhood reduced height as adults
A decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted into adulthood, although the decrease was not progressive or cumulative, according to recent study data.
“In prepubertal children, the use of inhaled glucocorticoids has been shown to reduce growth velocity, resulting in a linear growth reduction of 0.5 to 3.0 cm — approximately 1 cm on average — during the first few years of therapy,” H. William Kelly, PharmD, of the University of New Mexico Albuquerque, and colleagues wrote. “This reduction has been reported for low-to-medium doses, but the degree of reduction is dependent on the type of inhaled glucocorticoid and the delivery method.”
Prior studies using data from the Childhood Asthma Management Program (CAMP) clinical trial have indicated that children who received budesonide (Pulmicort Turbuhaler, AstraZeneca) experienced reduced height after 4.8 years of follow-up compared with children who received a placebo.
To continue the height follow-up of CAMP participants and evaluate the effects of budesonide vs. nedocromil (Tilade, Rhone-Poulenc Rorer) or placebo on adult height, the researchers measured the adult height of 943 participants who were randomly assigned to receive budesonide via dry-powder inhaler twice daily (400 mcg per day), nedocromil administered by means of a metered-dose inhaler twice daily (16 mg per day) or placebo.
Differences in adult height for each active treatment group, as compared with placebo, were calculated using multiple linear regressions with modification for demographic characteristics, asthma features and height at trial entry.
According to the study results, the mean adult height was 1.2 cm lower (95% CI, −1.9 to −0.5) in the budesonide group than in the placebo group (P=.001) and was 0.2 cm lower (95% CI, −0.9 to 0.5) in the nedocromil group than in the placebo group (P=.61).
In addition, a larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (P=.007). The decrease in adult height in the budesonide group vs. the placebo group was similar to that seen after 2 years of treatment (−1.3 cm; 95% CI, −1.7 to −0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred principally in prepubertal participants.
“The reduction in growth seen in the first few years of administration of inhaled glucocorticoids in prepubertal children persists as lowered adult height,” the researchers wrote. “However, in the information about inhaled glucocorticoids and their side effects that is provided to parents, the potential effect on adult height must be balanced against the large and well-established benefit of these drugs in controlling persistent asthma. It is appropriate to use the lowest effective dose for symptom control in order to minimize concern about the effects of inhaled glucocorticoids on adult height.”
Disclosure: The researchers report consulting relationships with Aerocrine, AstraZeneca, Genentech, MedImmune, Novartis, Schering-Plough, GlaxoSmithKline Merck, Dmagi, Lovelace Respiratory Research Institute and Sunovion; lecture relationships with GlaxoSmithKline; and grant support from Aerocrine, Genentech, GlaxoSmithKline, MedImmune, Merck and Thermofisher.
