July 17, 2014

expert reaction to two reviews on asthma and children’s growth

Two systematic reviews published in The Cochrane Library looked at the effects of inhaled corticosteroid drugs, given by inhalers to children with asthma, on growth rates, reporting growth slowed in the first year of treatment but effects were minimised by using lower doses.

Prof Jon Ayres, Professor of Environmental & Respiratory Medicine at the Institute of Occupational and Environmental Medicine, University of Birmingham, said:

“These studies confirm what many have suspected, that inhaled steroids can suppress growth in children.  However, the effect seems to be 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.

“The authors call for more research to quantify the effect more clearly but such studies will need to be large and consider a range of inhaled steroid types and doses.  In addition, care will need to be taken to assess dietary aspects of the children involved, something which has not been considered at all in previous studies where growth retardation was not the primary outcome.”

Dr Glenis Scadding, Consultant Physician in Allergy & Rhinology at the Royal National Throat, Nose and Ear Hospital, said:

“It is vital that parents do not stop giving their children asthma inhaled corticosteroid preventer medication, which reduces the death rate from asthma which still kills some thousands of sufferers each year.

“A risk factor for death is failure to take such medications with over-reliance on reliever treatments such as beta agonists.  What is needed is an attempt to keep the dose as low as possible by avoidance of factors, some allergic,  which trigger asthma in each child, plus consideration of other preventer approaches, including treating rhinitis, use of  non-steroid medications and immunotherapy.  The low number of  doctors trained in Allergy in the UK makes the approach to finding allergen triggers difficult.”

Samantha Walker, Director of Research and Policy at Asthma Research UK, said:

“Half a centimetre in growth is a small price to pay for medicine which may save your child’s life. Uncontrolled asthma can substantially increase the likelihood of asthma attacks, hospitalisation and even death and we know that inhaled steroids, taken regularly, significantly reduce the likelihood of these events happening. For a long time now people with asthma have told us they fear the side effects of taking asthma medicines but the good news is this evidence shows only a relatively minor impact from inhaled corticosteroids. No parent should therefore stop their children taking these lifesaving medicines”.

‘Inhaled corticosteroids in children with persistent asthma: effects on growth’ by L Zhang et al. and ‘Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth’ by AI Pruteanu et al published in Cochrane Database of Systematic Reviews 2014 on Thursday, July 17, 2014.

Declared interests

Glenis Scadding is an allergist, past President of British Society for Allergy and Clinical Immunology and does talks for Pharma companies which  produce  ICS, eg GSK, and which produce immunotherapy eg ALK, Stallergenes.