PEDIATRICS Vol. 91 No. 6 June 1993, pp. 1121-1126
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Long-term Effect of Inhaled Corticosteroids on Growth Rate in Adolescents With Asthma

Peter J.F.M. Merkus MD1, Philip H. Quanjer MD, PhD1, Elisabeth E.M. van Essen-Zandvliet MD2, Karel F. Kerrebijn MD, PhD2, Eric J. Duiverman MD, PhD3, and Hans C. van Houwelingen PhD4

1 From the Department of Physiology, Leiden University, Leiden, the Netherlands
2 From the Department of Paediatrics, Subdivision Paediatric Respiratory Medicine, Erasmus University of Rotterdam, University Hospital/Sophia Children's Hospital, Rotterdam, the Netherlands
3 Juliana Children's Hospital, The Hague, the Netherlands
4 From the Department of Medical Statistics, Leiden University

Background. Growth in stature in asthmatic adolescents may be delayed compared to normals as a result of treatment with inhaled corticosteroids (CS) or because of a delay in puberty. However, growth rates in asthmatic children have never been studied when treatment with CS was randomized and when growth was compared with that of matched healthy control subjects.

Objective. To assess the long-term effect of CS treatment on growth rates in asthmatic adolescents.

Methods. Participants were 40 asthmatic teenagers (mean age 12.8 years) who received randomized treatment with 0.2 mg of albuterol (salbutamol) with either placebo three times a day (BA + PL) or 0.2 mg of budesonide three times a day (BA + CS) for a median period of 22 months in a double-blind controlled study. Growth rates were compared with those of 80 control subjects who were matched for sex, age, height, and duration of follow-up.

Results. Growth rates in male patients, but not in female patients, were significantly less than in control subjects (P < .05), a finding consistent with a delay of puberty due to asthma. The mean difference (95% confidence interval) in growth rates between patients treated with BA + PL and their controls was -0.70 (–1.62, 0.22) cm/y; that between patients treated with BA + CS and their controls was -0.44 (–1.25, 0.37) cm/y. The observed mean (SEM) case-control difference between treatment groups was + 0.27 (0.58) cm/y in favor of BA + CS.

Conclusion. Growth retardation observed in adolescents with asthma may be due to a delay in puberty but not to the prescription of 0.6 mg of budesonide daily.

Key Words: adolescent growth spurt • asthma • case-control study • compliance with therapy

Submitted on August 3, 1992
Accepted on January 7, 1993




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