Inhaled Glucocorticoids in Children and Adult Height

Posted by • September 7th, 2012

In a randomized, controlled trial, the use of inhaled budesonide in childhood was associated with a decrease of 1.2 cm in attained adult height, as compared with placebo.

Inhaled glucocorticoids are the recommended therapy for persistent asthma in children. In prepubertal children, however, the use of inhaled glucocorticoids has been shown to reduce growth velocity, resulting in a linear growth reduction of 0.5 to 3.0 cm (approximately 1 cm on average) during the first few years of therapy.

Clinical Pearls

What was the effect on adult height in this study where participants aged of 5 to 13 years were randomly assigned to receive budesonide, nedocromil, or placebo daily for 4 to 6 years?

The adjusted mean adult height was 1.2 cm lower in the budesonide group than in the placebo group (171.1 cm vs. 172.3 cm, P=0.001); the mean adult height in the nedocromil group (172.1 cm) was similar to that in the placebo group (P=0.61). The height deficit observed at 1 to 2 years after treatment initiation persisted into adulthood, although the deficit was neither progressive nor cumulative over time.

How did glucocorticoid dose affect adult height?

The as-treated secondary analysis of the daily weight-adjusted dose of inhaled glucocorticoids during the first 2 years of the CAMP [Childhood Asthma Management Program] trial showed that a larger daily dose was associated with a lower adult height (−0.1 cm for each microgram per kilogram, P=0.007).

Morning Report Questions

Q: What other factors in study participants were associated with lower adult height?

A: Lower adult height was associated with Hispanic ethnic group (P<0.001) and female sex (P<0.001), as well as a higher Tanner stage (P<0.001), lower height (P<0.001), greater body-mass index (P<0.001), longer duration of asthma (P<0.001), skin-test reactivity (P<0.001), and vitamin D insufficiency (less than or equal to 30 ng per milliliter, P=0.004) at baseline.

Q: Did growth velocity differ dependent on patient age?

A: Overall, age trends with respect to growth velocity in the budesonide and placebo groups differed during the first 2 years of the trial for women (P=0.007) and men (P<0.001). For both sexes, the difference in velocity reduction that was seen in the first 2 years of assigned treatment in the budesonide group, as compared with the placebo group, was primarily among prepubertal participants (girls 5 to 10 years of age, P=0.001; girls 11 to 15 years of age, P=0.54; boys 5 to 11 years of age, P<0.001; and boys 12 to 15 years of age, P=0.57).

Comments are closed.