From the desk of Doc Smo: Once again, no free lunch (Article)

I can think of no pharmacological therapy in medicine that is free of unwanted side effects.   Even therapies that bestow great benefit seem to have  unintended consequences.  The September 2012 issue of the  New England Journal of Medicine featured an article that considered the impact of inhaled steroid treatment of asthma on adult height.  Physicians have speculated for a long time that  the frequent ingestion of in childhood reduces a child’s adult height, but what about the very small doses that are used in inhalers:  do  they have the same effect on adult height?

The authors of this article provide the first good, long-term data about the effect of inhaled steroids on growth.  According to these researchers, inhaled steroids reduce adult height by a very small amount:  an average of  1.8 cm or a ½ inches in children who used a common inhaled medication called “budesonide” ( brand name “Pulmicort”).   They confirm that even small doses of inhaled budesonide slow growth slightly with the effect persisting into adult life.  BUT, and this is a big capital letter BUT, the investigators say that this negative effect on ultimate height must be weighed against the tremendous benefit that children with persistent asthma receive in controlling a potentially life threatening disease.

As with vaccines, antibiotics, and even chemotherapy, the decision to use inhaled steroids requires weighing potential risks against anticipated benefits.  If the benefits are high and the risks are low, families and doctors should consider using inhaled steroids.  On the other hand, the article highlights the wisdom of  prescribing the minimum effective dose of these medications. Your comments are welcome at  Explore all the content while you are there.  Until next time, this is Dr. Paul Smolen wishing you and your family good health.


Smo Notes:

Kelly H, et al “Effect of inhaled glucocorticoids in childhood on adult height” New Engl J Med 2012; DOI: 10.1056/NEJMoa1203229.