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Do Inhaled Gluc..

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Asthma is a chronic disease resulting in breathing difficulties caused by narrowing of the airways.1 If proper treatment is not received patients often experience troublesome symptoms, and hospitalization and death can occur.1 Currently, inhaled glucocorticoids are recommended in children suffering from persistent asthma.2 However, previous studies have revealed reduced growth velocity in children receiving inhaled glucocorticoids which may alter adult height.3-5 The original Childhood Asthma Management Program (CAMP) clinical trial was a double-blind, placebo-controlled trial that included 1041 children between the ages of 5 and 13 years who were diagnosed with mild-to-moderate asthma.3 The study compared 200 micrograms of budesonide administered twice daily through a dry-powder inhaler, 8 mg of nedocromil administered twice daily through a metered-dose inhaler, and placebo.3 Children who received budesonide for a mean follow-up of 4.3 years were found to have a reduced growth velocity over the first 2 years, but were predicted to reach the same adult height as those children who received nedocromil or placebo.3 However, after an additional 4.8 years of follow-up children who received budesonide had a statistically significant decreased mean height (0.9 cm; P = 0.01) compared with the placebo group.6

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Colleagues of the CAMP Research Group aimed to continue follow-up with participants of the CAMP trial to examine the effects of budesonide and nedocromil on adult height.7 A total of 943 of the original 1041 participants were measured for adult height at a mean age of 24.9 years of age and 96.8% of measurements were obtained from women at least 18 years old and men at least 20 years old. Participants of the budesonide group had an adjusted mean adult height that was 1.2 cm lower than the placebo group (171.1 cm vs 172.3 cm, respectively, P=0.001), whereas participants who received nedocromil (172.1 cm) had heights similar to the placebo group (P=0.61).7 In addition, the reduced growth velocity observed in the budesonide group compared to placebo during the first two years of the original trial was primarily among prepubertal men (P<0.001) and women (P = 0.007).7 An as-treated secondary analysis was then conducted examining the daily weight-adjusted dose of inhaled glucocorticoids during the first two years of the trial and revealed larger daily doses were associated with lower adult height (-0.1 cm per mcg/kg, P = 0.007). However, there was no association of achieving adult height and the cumulative glucocorticoid dose. The investigators also found that lower adult height was significantly associated with baseline characteristics of Hispanic ethnicity, females, lower height, higher body mass, longer duration of asthma and skin-reactivity.7

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This follow-up of the CAMP trial revealed that the initiation of long-term inhaled glucocorticoids such as budesonide in children results in height deficits during the first few years of treatment and also continues into adulthood, but is not progressive.7 However, the authors note that although systemic effects of inhaled glucocorticoids are dose-dependent, these effects also depend on the therapeutic index of the medication as well as ...

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