CME - 2590


Inhaled glucocorticoids in childhood and adult height

Temporary reduction in growth velocity has been seen in pre-pubertal children using inhaled glucocorticoids for persistent asthma. However, the resulting decrease in attained height 1 - 4 years after starting this treatment is not thought to decrease attained adult height.

In this study, the authors measured adult height in 943 of 1 041 participants in the Childhood Asthma Management Program. Adult height was determined at a mean of 24.9 years. The participants (5 - 13 years old) were randomly assigned to receive 400 µg of budesonide, 16 mg nedocromil or placebo daily for 4 - 6 years. Differences in adult height were calculated for each active treatment group compared with placebo. Adult height was adjusted for demography, asthma features and height at trial entry.

Mean adult height was 1.2 cm lower (95% confidence interval [CI] −1.9 to −0.5) in the budesonide group than in the placebo group (p=0.001) and was 0.2 cm lower (95% CI −0.9 to 0.5) in the nedocromil group than in the placebo group (p=0.61). A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (−0.1 cm for each microgram per kilogram of body weight) (p=0.007). The reduction in adult height in the budesonide group compared with the placebo group was similar to that seen after 2 years of treatment (−1.3 cm; 95% CI −1.7 to −0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in pre-pubertal participants.

It appears that the initial decrease in attained height that was associated with the use of inhaled glucocorticoids in pre-pubertal children persisted as a reduction in height as adults. The decrease, however, was not progressive or cumulative.

Kelly HW, et al. N Engl J Med 2012;367:909-912.

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