- by Dr Gowher Pebbles n Pearl Pediatrics and Child Care
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- Jun 30 2017
Pediatric Corticosteroids Have Minimal Effect on Adult Height
(Source: N Engl J Med. 2012; 367:904-912. European Respiratory Society (ERS) 2012 Annual Congress. Presented September 3, 2012)
A large study presented here at the European Respiratory Society (ERS) 2012 Annual Congress showed that corticosteroid use to control asthma in children affected the height they attained as adults by only about 1 cm.
Anne Fuhlbrigge MD, from Brigham and Women's Hospital in Boston, Massachusetts, presented results from the Childhood Asthma Management Program (CAMP) trial in a joint ERS/NEJM Symposium. Concerns over adverse effects of glucocorticosteroids on bone mineral density prompted the study.
The CAMP investigators initially enrolled 1041 children aged 5 to 13 years with mild to moderate asthma who were randomly assigned to receive 400 μg budesonide, 16 mg nedocromil, or placebo daily for 4 to 6 years. Serial dual-energy X-ray absorptiometry scans of the lumbar spine for bone mineral density were performed in all patients.
Bone mineral accretion was determined annually in 84% of the initial cohort, or 531 boys and 346 girls who participated in CAMP. The median follow-up was 7 years. Adult height was measured at age 18 years in girls and age 20 in boys. If measurements were not made at these ages, measurements were taken later twice at intervals at least 1 year apart.
The investigators found that height differed by less than 1 cm between those who received corticosteroids during childhood and those who did not. Differences in adult height for each active treatment group compared with placebo were determined using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry.
According to Søren Pedersen, MD, PhD, from Kolding Hospital in Denmark, asthma can be controlled in most children at doses of 200 μg corticosteroids per day, but larger doses do not significantly affect outcomes. "More than 90% of dose-response studies have failed to show any difference between adjacent doubled doses of inhaled steroids on normally measured outcomes," Dr. Pedersen said.
Dr. Pedersen stressed that the adverse effects of uncontrolled asthma far outweigh concerns about the effect of corticosteroids on growth. "One year of inhaled glucocorticosteroid treatment increased the daily physical activity by 3 hours per week and resulted in markedly improved cardiovascular fitness," he pointed out.
Dr. Fuhlbrigge added that "the initial decrease of approximately 1 cm in attained height associated with the use of inhaled glucocorticoids in children persists as a reduction in adult height, but is neither progressive nor cumulative. The possible effect on adult height must be weighed against the well-established benefits of glucocorticosteroids in controlling asthma."
"It is appropriate to use the lowest effective dose [of corticosteroids] for symptom control to minimize concerns about adult height," she commented.
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