Back in 2012, I highlighted a study that was presented at the European Respiratory Society conference that focused on the link between the use of common asthma treatments and a child's height. In this study, researchers examined the use of budesonide, a corticosteroid that is the active ingredient in Pulmicort, a commonly prescribed asthma medication. This morning, two new studies were released that further the correlation between lower growth velocity and the use of corticosteroids.

Corticosteroids are commonly prescribed for persistent, moderate to severe asthma. Often inhaled, this type of drug is used to prevent asthma attacks. While the previous study focused on one particular corticosteroid, these latest studies expanded that to include six and five, respectively, different types of inhaled corticosteroid (ICS) drugs.

In the first study, six ICS and 25 trials involving nearly 8500 children were reviewed. Over the course of a year, there was about a .5 cm difference in growth between children who used ICS and those who used placebos or non-steroidal drugs. This review suggests much the same as the one mentioned in 2012, that though small, there is some reduction in growth velocity and overall height associated with the use of ICS. And again now, as then, the lead author of this most recent review suggests that the benefits of using ICS to control moderate to severe asthma outweighs this minimal, but significant, reduction in growth velocity.

In the second study, 22 trials were reviewed, with the main focus being the effect of low to medium doses on ICS on growth velocity. While the information collected was incomplete in the majority of the trails examined, a correlation between growth velocity and the amount of ICS administered was observed. Simply put, those with low dose ICS treatments experienced a smaller reduction in growth velocity than those who were treated with larger doses of ICS.

Overall, both studies highlight two points and further refine previous research. First, inhaled corticosteroids do have an impact on height/growth velocity. This is not limited to a particular type of corticosteroid and appears with many of the most common ones. Second, higher doses of ICS correlate with less growth. The smaller the dose, the less the effect on a child's height. Again though, it's worth repeating that they're not talking a major reduction in height, fractions of a centimeter annually. Most professionals who have either conducted these studies or have read them still agree that the benefits of ICS in controlling moderate to severe asthma outweigh this small reduction in height.

Studies like these are important for a few reasons. They highlight a potential side effect that has been previously not known or often discussed. It is also good to remember that these studies show results that effect more than just those who are coping with asthma. Some of the drugs used in the studies were beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone propionate and mometasone fumarate. These are the active ingredients used in common asthma AND allergy medications like

• Symbicort
• Pulmicort
• Elocon
• Flonase
• Veramyst
• Alvesco
• Omnaris
• Omnair

They also highlight the importance of what we do here at AchooAllergy. If blocking dust mites in your bedding or replacing carpet with hard flooring or using a high quality, HEPA air purifier reduces irritants in the home, the net benefit may likely be less reliance on medication and a lower risk of having to deal with the side effects. If your child has been diagnosed with moderate to severe asthma and inhaled corticosteroids are recommended, you should have a discussion with your doctor, and as is often the case with medication, the lowest dose that provides relief is the best dose.

To read more about the larger study of ICS on growth rates or the study of ICS doses and growth rates.

_Author: Kevin Gilmore