Glucocorticoid inhalers may impact adult height

Children with asthma who use glucocorticoid inhalers may grow shorter on average than those who do not use inhaled corticosteroids (ICS), according to a study published September 6 in the New England Journal of Medicine.

Previous studies have shown that the use of these drugs decreases growth rate, but it was believed that growth returned to normal after the first few years of therapy, according to lead author H. William Kelly, PharmD, of the University of New Mexico, Albuquerque, and colleagues. However, in this follow-up to the earlier Childhood Asthma Management Program (CAMP) clinical trial, the authors found that children who were given the glucocorticoid inhalers grew up to be on average one-half inch shorter than those who used placebo.

Beginning at aged 5 to 13 years, the researchers randomly assigned patients to receive 400 μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years.

At the mean age of 25 years, 943 of the original 1,041 patients were measured for adult height and weight. The authors found that patients who had taken budesonide during the trial had a mean height 1.2 cm shorter than those assigned to a placebo inhaler (171.1 cm vs 172.3 cm, 95% CI, -0.5 to -1.9 cm, P=.001). In addition, a larger daily dose was associated with a lower adult height (−0.1 cm for each microgram per kilogram, P=.007), and the deficit in adult height was greater for women (−1.8 cm, P=.001) than for men (−0.8, P=.10) and for participants who were younger at trial entry than for those who were older.

The mean adult height in the nedocromil group (172.1 cm) was similar to that of the placebo group (P=.61).

"The potential effect on adult height must be balanced against the large and well-established benefit of these drugs in controlling persistent asthma,” the authors cautioned. “It seems prudent to select inhaled glucocorticoids and devices with higher therapeutic indexes and to use them in the lowest effective doses in children with persistent asthma."