- Many studies in the past have shown that inhaled steroids can cause
growth retardation in the first year of use (1,2,3). This article
supports findings reported previously in a double-blind, randomized,
parallel group, multicenter study who were treated with fluticasone
and their heights measured for one year which show no significant effect
on adult height (5).
- The study also supports the findings in the CAMP study which was a
randomized treatment trial for more than 4 years in 1000 children with
mild to moderate asthma. It also noted that most of the difference
in growth amongst the budesonide-treated group occurred during the first
year of treatment. One weakness of that study is that it did not
report the child's pubertal status prior to entry or during the study
- This study was consistent with previous studies which showed a growth
rate reduction of 1.5 cm during the first year of receiving 400 micrograms
of inhaled beclomethasone per day.
- Many previous studies which demonstrated decreased adult height were
flawed in that they observed the decrease in velocity after one year
of use and then postulated further loss based on the trend (1,3).
- The CAMP study also shows that symptoms improved markedly in the budesonide-treated
group although there was no change in the FEV1 (2,3).
- The studies do not comment on the growth of other organs, such as
the brain or lung. Alveoli continue to be formed in the early
postnatal years up until the age of eight, with most of it occurring
during the first two years. Corticosteroids, accelerate the development
of lung features. When applied during a period of alveolar development,
this may result in decreased lung cell mass and too few abnormally large
- Agertoft L, Pedersen S. Effect of long-term treatment with
inhaled budesonide on adult height in children with asthma. The
New England Journal of Medicine, 2000; 343:1064-1069.
- The Childhood Asthma Management Program Research Group. Long-term
effects of budesonide or nedocromil in children with asthma. The
New England Journal of Medicine, 2000: 343:1054-1063.
- Wohl M, Majzoub J. Asthma, steroids, and growth (editorial).
The New England Journal of Medicine, 2000; 343:1113-1114.
- Freedman D, et al. Statistics (W. W. Norton & Company,
Inc., New York) 1991; 485-598.
- Mohr B. No long-term effects on
growth in asthmatic children using Flovent (CAT). University
of Michigan Pediatric EBM Web Site, 1999.