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“There are more hazards with undertreating asthma, such as losing days of school or even death, than there are side effects of asthma medications,” says William Lunn, MD, the director of the interventional pulmonary service at Baylor College of Medicine, in Houston. “As a doctor, I would hate for parents to get scared by reports and decide that their kids should not be treated with asthma medications.”
Here is a closer look at some of the major issues and controversies surrounding common asthma medications as well as some practical pointers for parents and patients of all ages.
What you may have heard:
Oral steroids suppress growth in children
Corticosteroids are powerful anti-inflammatory drugs that do a great job of suppressing the underlying inflammation that can lead to asthma attacks. They can either be inhaled or swallowed as a liquid, and include the drugs prednisone, prednisolone (an oral version of prednisone), Flovent, and Pulmicort. Although people often refer to them as steroids, they are not in the same class of drug as the muscle builders sometimes abused by athletes. You also may have heard that oral steroids can stunt a child’s growth. “Parents might be concerned about growth suppression in younger kids who take inhaled steroids for asthma,” says William J. Calhoun, MD, a professor of medicine and the vice chair of the department of medicine at the University of Texas Medical Branch, in Galveston.
• What the experts say: This is a legitimate concern, but unlikely, says Dr. Calhoun. In general, the much stronger oral steroids are given to children for only brief periods of time to combat the most severe asthma symptoms—especially those that might require hospitalizations. Inhaled steroids, on the other hand, may be taken by children daily on an ongoing basis. Because these are inhaled directly into the lungs (rather than swallowed and circulated throughout the body), experts believe they are much less likely to affect a child’s growth and do so to a much smaller degree. “The magnitude of growth suppression with properly managed asthma therapy is a quarter to one-half an inch in final adult height,” says Dr. Calhoun. He serves as the chairman of the Food and Drug Administration’s Pulmonary-Allergy Drugs Advisory Committee, but the views he is expressing are solely his own, and do not reflect those of the committee, he notes.
Some of the older inhaled corticosteroids may affect bone growth, but the newer inhaled steroids do not appear to affect growth to the same degree, he says. Why? Newer inhaled steroids are more effective than the older counterparts, and as a result, doctors can use smaller doses. What’s more, “the older steroids activated cellular pathways that caused slowing down of bone growth and the newer steroids don’t have that property,” Dr. Calhoun says.
• The bottom line: The growth suppression issue is not a reason to avoid these effective medications. “Uncontrolled asthma in childhood can also cause growth suppression because when asthma is not controlled, the child is sick all the time and growth can be compromised,” Dr. Calhoun stresses.
