Inhaled Steroids in Children with Asthma
Children with asthma often have to take inhaled corticosteroids like budesonide for long periods of time. Parents worry about the long-term effects of these drugs on their children’s growth. A new study funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) lets them breathe a little easier.
About five million children in the U.S. have asthma. It is a disease in which there is chronic inflammation of the airways in the lungs. The airways narrow when exposed to certain irritants like viruses, smoke, or pollen and make it hard to breathe, causing coughing, wheezing, chest tightness, and shortness of breath. Asthma can’t be cured, but you can take medicines to control it.
The new study, carried out by The Childhood Asthma Management Program Research Group, randomly assigned 1041 children from five to twelve years of age with mild to moderate asthma to three different groups. All used the standard type of medicine to treat an asthma attack, but for long-term treatment one group took the corticosteroid budesonide twice a day, one group took a non-steroidal anti-inflammatory drug called nedocromil, and one took a placebo. The children were followed for four to six years.
Asthma was controlled best in the group taking budesonide. That group had fewer urgent-care and hospital visits, more episode-free days, and less need for other potent drugs to treat their asthma. The nedocromil group showed improvement in some respects, but the results weren’t nearly as strong as with budesonide.
Previous studies had raised concerns that children taking corticosteroids for long periods of time could have stunted growth. This study showed that those taking budenoside had a slower growth rate initially — they were about 3/8 inch shorter than the children in the other two groups at the end of the first year. But afterwards, the growth rate for those on budesonide was identical to the other two groups. Tests at the end of the study suggest that the children taking the corticosteroid will likely reach their normal heights as adults.
The researchers concluded that continuous daily treatment with inhaled budesonide leads to better control of asthma in children over five years of age who have mild to moderate asthma, with the only side effect being a small and temporary slowing of growth. An editorial that accompanied the published study noted that it does not tell us about the use of the medication in children who are either younger than five or who have very mild asthma.
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