To Treat Asthma, Inhaled Steroids Don't Permanently Stunt Kids' Growth

      Inhaled steroids - a standard treatment for children with severe asthma - do not permanently stunt growth, as doctors had feared.

      Doctors knew that steroids cut growth by about a third of an inch (7 millimeters) a year when children start using them, and had worried that youngsters'' growth might continue to lag that much every year.

      But the first research to take a long look at the drugs - a five-year U.S. study and a 10-year study in Kolding, Denmark - found that the effect is temporary and children resume normal growth after about a year.

      The U.S. study further found that inhaled steroids can help control symptoms even in mild cases.

      Up to now, doctors knew that in children with severe cases of asthma, steroids'' effectiveness outweighed any side effects. But they weren''t sure whether that was true in mild cases.

      ``We hope these results will convince more physicians, and parents as well, that treating children with mild to moderate asthma with inhaled corticosteroids will result in better asthma control and improved quality of life,'' said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, which paid for the U.S. study.

      The findings are reassuring news for both doctors and parents, said Dr. Cleveland Moore, pediatric director at LSU''s Morial Asthma Center.

      The study at Kolding Hospital and the one at eight U.S. centers were published in Thursday''s New England Journal of Medicine.

      The Danish team looked at the steroid budesonide''s effect on the height of 211 people. They had spent an average of nine years on the drug.

      The U.S. study looked at both a steroid and a non-steroidal anti-inflammatory inhaler and their various effects on children with mild to moderate asthma.

      ``When asthma is more severe, steroids are clearly the drug of choice, even though there is slight growth retardation,'' said Dr. N. Franklin Adkinson, executive director of the eight-center Childhood Asthma Management Research Group. ``Our focus was on mild asthma because there is no consensus that inhaled steroids are the drug of choice.''

      The steroid was much better than the other anti-inflammatory drug, nedocromil, at reducing the heightened sensitivity that turns allergies into asthma.

      Both medicines also cut down the number of emergency room and urgent doctor visits, with budesonide doing better than nedocromil. Budesonide also had benefits the other drug did not: less time spent in the hospital, less need for other asthma medicines, and more days without asthma attacks.

      However, doctors did not find one improvement they had hoped for: better lung capacity. That may indicate that the children''s lungs already had been damaged irreversibly, Lenfant and Moore said.

      ``This tells me these young kids need to be started with therapy with inhaled steroids early in life - within two years of developing the disease,'' Moore said.

      The NIH institute plans studies to look at asthma treatments in younger children.

      On the Net:

      American Academy of Allergy, Asthma and Immunology: http://www.aaaai.org/

      Johns Hopkins University Asthma and Allergy Center: http://www.hopkins-allergy.org/

      National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/index.htm

     

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