Sunday, October 9, 2011

Steroids for Wheezing Slow Growth in Smallest Kids

From Reuters Health Information By Anne Harding NEW YORK (Reuters Health) Sep 29 - Fluticasone treatment will not stunt growth in most preschoolers with recurrent wheezing, a new study shows. But the youngest, smallest children on corticosteroids did show a significant slowing of growth compared to their peers on placebo, Dr. Theresa W. Guilbert of the University of Wisconsin-Madison and her colleagues found. "We speculate that this may have been a dose response, that smaller children getting the same amount of medication that the bigger or older children got caused them to have a decreased height velocity," Dr. Guilbert told Reuters Health. However, she added, more study is needed given that the new findings are based on a post-hoc analysis. Dr. Guilbert and her team reported their findings online August 5 in the Journal of Allergy and Clinical Immunology. In a study of the same group of children who were two or three years old at baseline and at high risk of asthma, the researchers had previously found that those who received daily corticosteroid treatment for two years grew 1.1 centimeter less than the study participants on placebo. However, the fluticasone-treated children caught up in the first year after they stopped receiving treatment, so the difference in height between the intervention and placebo groups was no longer significant. The current study looks at growth among study participants two years after the end of treatment. Overall, the researchers found, the children on fluticasone grew 0.2 cm less than the children on placebo, which was not a statistically significant difference. However, two-year-olds who weighed less than 15 kilograms at baseline had 1.6 cm less linear growth than children of the same age and weight who were given placebo (p=0.009). Every child in the treatment group received 176 micrograms of fluticasone propionate per day. Giving smaller children a lower dose, or only giving them medication during the viral season, could offset the drug's potential effects on growth, Dr. Guilbert said in an interview. "You have to weigh the risk and benefit," she added. "We know it's an effective medication in these children, but the dose and the way you give it might be something you consider on a child-to-child basis. That and watching their growth very closely." Dr. Guilbert and her team are conducting another study comparing daily steroids to higher-dose steroid treatment when a child has a cold to determine which is best, and they plan to look at growth as a secondary outcome of this study as well. "That will also shed some light on an additional way that an inhaled steroid could be used in this population," the researcher said. The current study was funded by several grants from the National Institutes of Health. Dr. Guilbert has consulted for GlaxoSmithKline, which makes Flonase, the brand-name version of fluticasone, as have some of her co-authors. SOURCE: J Allergy Clin Immunol 2011.

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