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Editorial
Long-term administration of systemic steroids
is a cause of impaired growth. (1) Trials comparing inhaled
steroid preparations with other treatment regimens in nearly 600
children with asthma found that, children treated with inhaled
steroids had less growth in height (1 to 1.6 cm [23 to 27 percent]
less) than those assigned to other treatments.
The mechanisms by which this delay in growth occurs are unknown.
If inhaled steroids are not discontinued, does growth suppression
continue, so that children with asthma who are at the 50th percentile
for height at the age of six years fall to the 25th percentile by
the time they are adults?
Two articles in this issue of NEJM report a reduction of about
20 percent in growth velocity during the first year of treatment.
One caveat is that their may be impairment
of the growth of other organs, such as the brain (9) and the lung.
The number and branching structure of airways and conducting vessels
are complete in early gestation, whereas alveoli are formed in the
last months of gestation and during the first years of postnatal
life. The number of alveoli increases by a factor of about six after
birth, mostly in the first two years. Formation of alveoli is complete
by the age of five to eight years. (10,11) Thereafter, the lung
grows by increasing the size of airways and alveoli already present.
Until more is known about the influence of steroids on the development
of the lung and other organs, and until better tools are developed
to assess organ growth, it may be prudent to avoid the use of inhaled
corticosteroids in young children with mild asthma.
The sparseness of the data on the influence of steroids on organ
development cautions against extending the beneficial findings of
the studies of Agertoft and Pedersen and the Childhood Asthma Management
Program Research Group to young children, particularly those with
relatively mild disease.
The New England Journal of Medicine
-- October 12, 2000 -- Vol. 343, No. 15
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