An estimated 300 million people worldwide suffer from asthma. This number is growing, and when the condition isn’t properly controlled, it can lead to serious lung damage of even death. As part of the Global Asthma Initiative guidance, giving a temporary high dose of steroid to children is recommended when they don’t have other strategies for controlling their asthma. These steroids are commonly used, particularly in the US and UK.

However, a new study has shown that using a higher dose steroid inhaler might not be beneficial to children, and might even be causing growth problems. The scientists who conducted the study found that the increased dose had very little impact on the number of attacks the children had when compared to those taking their regular dose.

During the 48 week study in the US, 254 children aged 5-11 were monitored. It found that the children on the higher dose had grown at a slower rate than those who weren’t – growing an average of 0.23cm less per year on average. They were also exposed to more harmful steroids. The authors noted: “The association with slower growth in height … observed in the high-dose group was unexpected.”

Even though the difference in growth was small, it’s important to consider that those children on the higher dose returned to a regular dose after just two weeks. It’s feared that long term use could have a serious impact on their growth. “This relationship arouses the concern that more frequent or prolonged use of this strategy, if the use of inhaled glucocorticoids was its cause, could lead to greater adverse effects.”

Study lead Dr Daniel Jackson, associate professor of paediatrics at the University of Wisconsin School of Medicine and Public Health said: “Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children. But these findings suggest that a short-term increase, to high-dose inhaled steroids, should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids.”

But, other scientists have pointed out that although there are potential side effects to higher dose steroids, they can prevent potentially fatal asthma attacks in young children. Dr Philip Bardin, of the Monash University and Medical Centre in Melbourne, Australia said: “Exacerbations are frequently heralded by slowly declining lung function and increasing asthma symptoms.”

“These acute flares of asthma are detrimental because they adversely affect quality of life, lung function and healthcare costs, and have the potential to end in death. Asthma specialists have long thought that this condition, termed the “yellow zone”, provides the perfect timing for initiating more aggressive care.”

Dr James Kiley, director of the lung diseases division of the US National Heart, Lung and Blood Institute added: “This study allows caregivers to make informed decisions about how to treat their young patients with asthma. Trials like this can be used in the development of treatment guidelines for children with asthma.”

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