Children who use inhaled steroids to control their asthma do not have to worry about stunting their growth, according to a study in the New England Journal of Medicine. In addition, steroidal therapy provides better treatment for asthma than non-steroidal therapy in terms of significantly reducing the number of hospitalizations and urgent care visits, as well as the need for additional asthma medications. The findings are reported by the Childhood Asthma Management Program Research Group (CAMP), a consortium of eight medical centers in the United States and Canada.
"This study shows that the best asthma drug can be given to children without having to worry about any long-term adverse effects on growth and development," says N. Franklin Adkinson Jr., M.D., a professor of allergy and clinical immunology and director of CAMP at Johns Hopkins School of Medicine. "Earlier studies have shown that moderate doses of inhaled steroids stunt the growth of children by 1 centimeter per year. Some patients may be on the medications for 10 years or more, and so this could have meant that these children would be 4 inches shorter than their non-asthmatic classmates. The CAMP study clearly shows that the effect on growth suppression is transient and growth velocity returns to normal after about a year. A second study from Denmark in the same issue of the journal confirms this finding."
Current guidelines recommend a variety of medications for controlling mild asthma, either an inhaled corticosteroid or a non-steroidal drug like nedocromil or oral medicines. CAMP set out to investigate whether steroidal drugs had any long-term adverse effects and whether the medications could have a positive effect in the long run of increasing lung growth. Previous studies have suggested that asthma can impair lung growth during childhood, leading to reduced pulmonary function in adulthood.
The researchers recruited 1,041 children with mild asthma, ages 5 to 12 years, and randomly assigned them to be treated with either the inhaled steroid budesonide, the non-steroid nedocomil or a placebo. They also provided each patient with bronchodilator asthma medicines as needed. The researchers found that while the inhaled steroid stunted growth by roughly four-tenths of an inch at year one, this adverse effect was short-lived. "By year four, all the kids were equal as a group in that they had the same height, weight, and every other physical measurement including bone density, sexual maturation and psychological development," says Adkinson. Neither medication improved lung growth.
The doctors also discovered that the steroidal drugs provided better treatment than the non-steroidal drugs or placebo in terms of significantly reducing the number of hospitalizations and urgent care visits, as well as the need for additional asthma medications.
"This is really good news," says Adkinson. "Parents are understandably cautious about treatments for their children that are in any way risky. This study provides some reassurance about the safety of this most effective class of asthma drugs. Hopefully, it will also change prescribing habits of physicians who have been reluctant to use inhaled steroids in milder asthmatic children."
CAMP was coordinated by the Johns Hopkins Center for Clinical trials at Johns Hopkins School of Public Health and conducted at 8 clinical centers: ASTHMA Inc. in Seattle, Brigham & Women's Hospital in Boston, The Hospital for Sick Children in Toronto, Johns Hopkins Asthma & Allergy Center, National Jewish Medical and Research Center in Denver, University of California at San Diego, University of New Mexico in Albuquerque, and Washington University in St. Louis. Between 12 million and 15 million people, including close to 5 million children, in the United States have asthma. Asthma is a chronic disease through which airflow in and out of the lungs may be blocked by muscle squeezing, swelling and excess mucus. In 1997, more than 30.5 million prescriptions were filled for asthma medication, and patients had approximately 1.2 million emergency room visits and 445,000 hospitalization days.
Authors of the study include Bruce Bender, Ph.D., and Reuben Cherniack, M.D., from National Jewish Medical and Research Center; N. Franklin Adkinson Jr., M.D., from Johns Hopkins School of Medicine; James Tonascia, Ph.D., Alice Sternberg, Sc.M., Michele Donithoan, and Mark Van Natta from the Johns Hopkins School of Public Health; H. William Kelly, PharmD, from the University of New Mexico in Albuquerque; Joseph Reisman, M.D., from The Hospital for Sick Children; Gail G. Shapiro, M.D., from ASTHMA Inc; Robert Strunk, M.D., from Washington University; Margaret Wu, Ph.D., and Virginia Taggart from the National Heart, Lung, and Blood Institute; Scott Weiss, M.D., from Brigham & Women's Hospital; Robert Wise, M.D., and Stanley Szefler, M.D., from the National Jewish Medical and Research Center; and Robert Zeiger, Ph.D., from the University of California at San Diego. The study was funded by the National Heart, Lung, and Blood Institute.
Journal
New England Journal of Medicine