Asthma , inhaled corticosteroid treatment , and growth Titus

To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0-01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1-50) and after (-1-55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth. Department of Child Health, University of Aberdeen Titus K Ninan George Russell Correspondence to: Dr Titus K Ninan, Department of Child Health, Polwarth Building, Foresterhill, Aberdeen AB9 2ZD. Reprints available from: Dr George Russell, Department of Medical Paediatrics, Royal Aberdeen Children's Hospital, Cornhill Road, Aberdeen ABI 8NB. Accepted 10 February 1992 Inhaled corticosteroid treatment (ICT) has been used to treat moderate to severe asthma since the early 1970s,' 2 the two drugs most commonly used in the UK are beclomethasone dipropionate and budesonide. Occasional minor side effects such as oral thrush, dysphonia, and hoarseness have been reported. 1 3 Adrenal suppression has been observed in patients on ICT, but the dose at which this occurs varies. Some investigators have noted evidence of adrenal suppression in patients on conventional doses of ICT,4 5 while others have found adrenal dysfunction only with higher than conventionally recommended doses.' 6 Growth retardation in severe childhood asthma was described long before the introduction of ICT79; it also occurs as a complication of long term systemic corticosteroid treatment for asthma.'0 11 The effect of ICT on linear growth, is however, controversial. 3 12-14 This study evaluated the effects of ICT and the severity of asthma on linear growth in prepubertal children with severe chronic bronchial asthma, many of whom were poorly controlled despite higher than conventionally recommended doses of ICT. Patients and methods The growth of 58 children (38 boys and 20 girls) with chronic asthma was followed up for a mean duration of 4f9 years (range 2-6-9-4 years). The children studied were suffering from recurrent or chronic asthma, which was sufficiently severe to require regular hospital review that included assessment of their growth. Height was measured on the same stadiometer by a small group of nurses who were also responsible for measuring children attending the local growth centre, thus ensuring a standardised technique. Asthma control was assessed by a symptom score based on the frequency, duration, and severity of wheezing and on the number of days per week on which rescue medication (systemic steroids or bronchodilator treatment) was used (table 1). For each category a score of 0-4 was given to produce a maximum of 16 points. A score of 5 or less was classed as good control, 6-10 as moderate control, and greater than 10 as poor control. Each of these children were followed up for a minimum of one year when not receiving ICT and for at least another year when on a continuous ICT. To avoid pubertal influences, growth was studied in boys until the 11th birthday and in girls up to the 10th birthday. The mean age of entry into the study was 3 5 years for boys and 4-4 years for girls. The mean age of exit from the study was 9 years for boys and 7 5 years for girls. Each child was treated initially with 2 receptor stimulants, theophylline, and/or sodium cromoglycate for a mean duration of 1 8 years (range 1-6'5 years). Because of inadequate control of interval symptoms the children were then started on ICT (budesonide or beclomethasone dipropionate). The selection of drug was based on the type of inhalation device which the patient was best able to use: budesonide was generally given by a large spacer (Nebuhaler, Astra) whereas beclomethasone dipropionate was generally given by metered dose inhaler or dry powder inhaler (Rotahaler, Allen and Hanburys). Table 1 Asthma symptom score