Early asthma medication leads to stunted growth

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Infants given asthma medications during their first 2 years of age are likely to be stunted in later life, according to research. The findings highlight the importance of using these medicines in infants appropriately.

Inhaled corticosteroids (ICS) – medications used to treat conditions such as asthma – are frequently used in infants with recurrent wheezing. However, these medications may have harmful effects, for instance a reduced growth rate in development and a shorter height in adulthood.

In this study, researchers from Kuopio University Hospital and University of Eastern Finland analysed information on the height, weight and asthma medicine intake of 12,482 Finnish children aged 0-24 months. The researchers found that children who used inhaled corticosteroids during the first 2 years of life were too short for their age. This result was more evident in children taking the asthma medicine budesonide for more than 6 months.

Many factors that alter development in children, such as chronic illnesses and long-term use of oral corticosteroids, may cause a shorter than normal height in adulthood. “Previously, the impact of corticosteroids on growth was looked at in older children and was thought to alter growth only temporarily,” said lead researcher Dr Antti Saari. “However, studies on inhaled corticosteroid use in infants are practically lacking and thus this has been questioned in the recent study. Our research shows a link between long-term treatment of ICS during infancy and stunted growth at or after the age of 2 in otherwise healthy children.”

The group will next focus on assessing the impact of inhaled corticosteroids on growth in older children and observe them for longer time periods. “According to our research, we could only assess the impact of inhaled corticosteroids on growth in infancy until 2 to 3 years of age. The longitudinal impact of these medications is not clear and we would therefore like to investigate this further,” said Saari.

Background: Inhaled corticosteroids (ICS) are used frequently in infants with recurrent wheezing. They may have potential adverse effects as treatment of childhood asthma with ICS decreases growth velocity and adult height. ICS treatment in infancy is thought to alter linear growth only little, but however, studies on ICS use in infancy and linear growth are practically lacking.
Objective and hypotheses: To evaluate the impact of ICS on linear growth during infancy.
Method: A population-based cohort of 6391 boys and 6091 girls with data on primary care height and weight measurements, parental heights and drug purchases from birth to 24 months was collected. Height-for-age deviation from the target height (TH) and height velocity (HV) were calculated, and expressed as z-scores (zTH and zHV) at the median age of 24 months (interquartile range 24–26 months). These were compared between ICS (fluticasone and budesonide) exposed and unexposed infants using the analysis of covariance with maternal, perinatal, auxological and medication factors as covariates.
Results: ICS exposed infants were on average shorter than the unexposed infants ((adjusted zTH and zHV differences −0.16 (95% CI −0.22 to −0.11, P<0.001) and −0.28 (−0.37 to −0.19, P<0.001)). The effect was most pronounced after exposure to budesonide prior to 12 months of age (zTH −0.31 (−0.46 to −0.16) and zHV −0.34 (−0.58 to −0.09)) or lasting more than 6 months (zTH −0.63 (−0.89 to −0.37) and zHV −0.70 (−1.13 to −0.27)).
Conclusion: Long-term treatment of ICS during infancy was associated with stunted growth at or after the age of 24 months in otherwise healthy children. Stunting of linear growth in infancy may cause permanent loss of growth potential with decreased adult height. These observations highlight the importance of appropriate use of inhaled corticosteroids in infants.

Bioscientifica material
ESPE 2015 abstract

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