Inhaled corticosteroids may stunt growth in infants with asthma

Children under the age of two prescribed inhaled corticosteroids for the treatment of asthma or recurrent wheezing may get more than respiratory relief, according to a new report.

Research presented at the 54th Annual European Society of Paediatric Endocrinology earlier this month revealed that infants using inhaled corticosteroids may face slower growth rates and shorter heights in adulthood as a result of using the medication.

"Growth effect of inhaled corticosteroids is insufficiently explored in infants. However, few previous studies did not find any association between inhaled corticosteroids and stunted growth in infancy," lead researcher Antti Saari, MD, of the University of Eastern Finland and Kuopio University Hospital in Finland told Medical Economics. "According to our study, growth will be reduced after six months of treatment."

The study involved more than 12,000 Finnish children younger than 24 months of age. Children in that age range who used inhaled corticosteroids were too short for their age, according to the study, and the effect was particularly evidence in children that took budesonide for more than six months while they were younger than 12 months of age.

Saari noted that previous studies linked growth retardation in older children with long-term illness and oral corticosteroid use, but the effects were thought to be temporary.

Inhaled corticosteroids are used regularly in infants with asthma, due to its proven efficacy.

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A 2015 report presented to the American Academy of Allergy, Asthma & Immunology evaluated the use of inhaled corticosteroids in 1,500 children under age 5-31% of whom were under 12 months of age-and found that the medication resulted in a 99% reduction in emergency department visits, 93% fewer hospitalizations, and a 100% reduction in oral corticosteroid use.

Similarly, a 2013 report in Current Opinion in Pulmonary Medicine found that daily treatment of 100 μg to 200 μg of inhaled corticosteroids lead to significant improvements in the symptoms of infants and preschoolers suspected of having asthma. That study, too, however, noted associations between inhaled corticosteroids and growth.

Another 2015 study published in PLOS ONE also indicated a connection between growth retardation and oral corticosteroid use. In that study, researchers revealed the final effect of long-term inhaled corticosteroid use can be a loss of roughly 1 centimeter-representing a 0.7% height loss.

That study also noted that adverse effect may be mitigated in children whose asthma is under better control allowing for increased physical activity, who have fewer exacerbations requiring additional short courses of oral corticosteroids, and who are over age 10 at the time of treatment.

Other treatment options for infants with asthma may include leukotriene modifiers and bronchodilators, but short-acting beta agonists are the recommended first-line therapy in children under age 4 along with techniques to prevent exacerbations, according an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee (CC), coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Saari says the next step in his research is to evaluate the effects of inhaled corticosteroids in older children for a longer period of time. In the interim, Saari recommends that practitioners prescribe inhaled corticosteroids with caution in infants.