Steroids Don't Stunt Asthmatics' Long-Term Growth, Reports Says

      While inhaled steroid drugs can dramatically improve asthmatics'' lives, hints that they might shorten children''s growth spurts have left many parents agonizing over their use.

      In reports being published today (Thursday), two treatment studies conclude that such fears are groundless: Although the steroids can slow growth for a while, the children catch up to reach their natural adult height.

      It is good news for parents of the 5 million children and teen-agers in the United States who suffer from asthma, the lung and airway constricting disease that is rising at an epidemic pace.

      ``Parents can be reassured that this treatment is safe and effective, and they don''t need to worry about long-term height effects,'' said Dr. Scott Weiss, a researcher at Brigham and Women''s Hospital and a lead author of the report being published Thursday in the New England Journal of Medicine.

      Weiss is an investigator with the Childhood Asthma Management Program, which carried out the largest and longest study to date of childhood asthma treatment. The study he led checked 1,041 children ages 5 through 12 over four years in Boston and seven other cities.

      The Childhood Asthma Management Program report, and a Danish study of 211 children, both found that the steroids'' growth-dampening effect lasts only about one year.

      The U.S. researchers compared 311 children who took the steroid drug budesonide, sold as Pulmacort, with 312 who took another drug, nedocromil, and 418 taking an inactive placebo. There was no significant difference in height among the three groups at the end of the four-year period.

      The height issue raised parents'' anxieties in recent years, as studies only a year or less in length had suggested that the steroids might leave children an inch or two shorter than their expected height.

      The inhalers that asthmatics use when they are wheezing or short of breath are designed to open narrowed breathing passages in the lungs that overreact to stimuli such as cold air, smoke and dust.

      The steroids, which are prescribed for routine use by children with mild but persistent asthma, dampen the inflammation that underlies the asthma symptoms.

      The Pulmacort and similar steroid inhalers are so effective that parents often ``see that their children need fewer medications to treat their symptoms, and their child will almost seem not to have asthma,'' said Nancy Sander, president of the Allergy and Asthma Network/Mothers of Asthmatics Inc., a support and advocacy group.

      ``I think when parents hear this message they will be greatly encouraged, because a lot of parents are very worried that their child''s growth is going to be stunted,'' Sander said.

      Such fears have led some parents to comply only spottily with doctors'' instructions on the inhaled steroid. When their child has a flare-up, Sander said, some parents say, ``OK, I''ll give it long enough to get them by'' the immediate crisis, ``but not long enough so they stop growing.'' The result is poorly controlled asthma, she said.

      The Childhood Asthma Management Program study also was designed to test the effectiveness of inhaled steroids in patients with mild to moderate asthma.

      Compared with children who got a placebo, those who took the steroid drug had fewer hospitalizations and urgent visits for medical care, less need for other asthma medications and less need for oral steroids that are used when symptoms are severe.

      However, Weiss said, the researchers were surprised and disappointed when the study found that the steroids did not improve the children''s overall lung capacity.

      ``The drug doesn''t seem to really influence the natural course of the disease at all,'' Weiss said.

      Persistent childhood asthma is believed to alter the linings of the air passages in a way that can lead to obstructive pulmonary disease later in life. Weiss said the Childhood Asthma Management Program researchers had hoped that the steroids would prevent this from happening.

      One possibility, Weiss said, is that aggressive treatment should be started earlier than the age - 5 - that was the beginning of treatment in the program study.

      But Dr. Mary Ellen B. Wohl, chief of respiratory diseases at Children''s Hospital, advised caution in giving inhaled steroids to children younger than 5.

      Her concern, said Wohl, who was lead author of an editorial accompanying the journal reports, was of the steroids'' effects on the developing lungs and brain.

      (The Boston Globe Web site is at http://www.boston.com/globe/)

     

c.2000 The Boston Globe