New research shows that children who use inhalers from a young age may suffer stunted growth–of about half a centimeter. With all the news headlines giving us breathless reports on this, it’s important to put the findings into perspective.
It’s estimated that about 300 million people worldwide suffer from asthma, with rates rising in so-called developed nations. Drugs called corticosteroids, taken through an asthma reliever inhaler, are prescribed as a first line of treatment because they can rapidly and efficiently help to open restricted airways and allow for normal breathing to resume. However, individual research papers have indicated that corticosteroid asthma treatments might have a small impact on a child’s growth. With their latest review, scientists wanted to see if those individual findings stood up to more in-depth study.
The research, published this month in The Cochrane Library journal, involved two separate systematic reviews of trails and papers relating to asthma treatment and its effects in young people. After applying strict selection criteria, Canadian and Brazilian researchers were able to whittle down prospective studies to 25 trials, most of them blinded, that involved 8471 children in total, breaking down into 5128 children receiving steroidal asthma treatment and 3343 children who were on non-steroidal treatment as controls. All the children had mild to moderate persistent asthma.
The children receiving corticosteroids were all on low to medium daily doses of the main six molecules used to treat asthma (for a full list, please click here), and received treatment for at least three months and up to six years.
The authors found that, after looking at both reviews of the data, corticosteroid asthma treatments used regularly at a low or medium daily dose could reduce growth in children by up to nearly half a centimeter, though the retardation of growth was less pronounced in children receiving a lower dose. It should also be noted that the problem appears to manifest most strongly during the first year of treatment–so children are not going to lose a half-a-centimeter of growth for every year they use a corticosteroid inhaler, with minimal effects after that first year.
“The evidence we reviewed suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment,” Dr Linjie Zhang of the Federal University of Rio Grande, Brazil, and lead author of the research, is quoted as saying. “But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs.”
So if we strip away the scare-stories, what is the important takeaway from this research?
Scientists and doctors alike are keen to stress that parents should not be wary of corticosteroid inhalers as they remain the best treatment for asthma-related breathing problems and their effectiveness at preventing serious attacks, hospitalization and death remains solid.
The researchers suggest though that doctors should be proscribing the minimum dosage necessary for effective treatment until future research can pin down the exact role that treatments, daily dose, inhalation device and patient age all play in possible growth suppression.
“These studies confirm what many have suspected, that inhaled steroids can suppress growth in children,” said Jon Ayres, a professor of environmental and respiratory medicine at Britain’s Birmingham University who wasn’t part of this review. “However, the effect seems… small and non-cumulative and many may consider this a risk worth taking compared to the alternative, which is poorly controlled and therefore potentially life threatening asthma.”
In short, while of course there is an interest in minimizing the side-effects of asthma treatments, these findings should not prompt parents to worry and certainly shouldn’t be cause to stop children managing their asthma with corticosteroid inhalers.
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