Asthma drugs suppress children's growth say researchers

Corticosteroid drugs that are given by inhalers to children with asthma may suppress their growth, evidence suggests.

Two new systematic reviews published in The Cochrane Library focus on the effects of inhaled corticosteroid drugs (ICS) on growth rates.

The authors found children’s growth slowed in the first year of treatment, although the effects were minimized by using lower doses.

Inhaled corticosteroids are prescribed as first-line treatments for adults and children with persistent asthma.

They are the most effective drugs for controlling asthma and clearly reduce asthma deaths, hospital visits and the number and severity of exacerbations, and improve quality of life.

Yet, their potential effect on the growth of children is a source of worry for parents and doctors.

Worldwide, seven ICS drugs are currently available: beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone and triamcinolone.

Ciclesonide, fluticasone and mometasone are newer and supposedly safer drugs.

The first systematic review focused on 25 trials involving 8,471 children up to 18 years old with mild to moderate persistent asthma.

These trials tested all available inhaled corticosteroids except triamcinolone and showed that, as a group, they suppressed growth rates when compared to placebos or non-steroidal drugs. 14 of the trials, involving 5,717 children, reported growth over a year.

The average growth rate, which was around 6-9 cm per year in control groups, was reduced by about 0.5 cm in treatment groups.

The researchers found that growth suppression varied across studies, and so they looked at the relationship between a variety of factors and their effects on growth. Some of the variation could be explained by the drugs used, although since this was an indirect comparison the authors say more evidence is needed.

“Conclusions about the superiority of one drug over another should be confirmed by further trials that directly compare the drugs,” said Zhang.

More long-term trials and trials comparing different doses are also needed, particularly in children with more severe asthma requiring higher doses of inhaled corticosteroids, the researchers conclude.

“Only 14% of the trials we looked at monitored growth in a systematic way for over a year. This is a matter of major concern given the importance of this topic,” said Francine Ducharme, one of the authors of both reviews and senior author of the second review, based at the Department of Paediatrics at the University of Montreal in Montreal, Canada.

“We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available. Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing inhaled corticosteroids in children.”

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Experts probe possible link between asthma inhalers and birth defects

An inquiry will look at prescription
drug usage during pregnancy.

A Europe-wide study will be following thousands of pregnant women taking prescription drugs for asthma, epilepsy, diabetes and depression to see if there is an increased risk of birth defects and health problems in babies.

The study will examine nearly four million births and concentrate in asthma inhalers, man-made insulin, new anti-epileptics and Prozac-style anti-depressants called SSRIs, which many pregnant women with chronic conditions need to take even during pregnancy.

The researchers urged pregnant women to keep taking their medications and to talk to their health care providers if they are worried.

Traditionally, women have been cautioned to be careful with drugs during pregnancy because it is very difficult to establish safety in pregnancy.

Some prescription drugs have already been linked to birth defects or health problems, including preventive asthma inhalers, which can increase the risk of hormonal and metabolic disorders in infants.

Doctors say that risks need to be weighed with the benefits of taking medications and that more research is needed to determine the risks.

Source: The Daily Mail

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Asthma awareness: Over-the-counter inhalers disappear from shelves

No more over-the-counter asthma inhalers

Pharmacies in the United States have to rearrange at least one of their shelves, after a popular over-the-counter asthma inhaler has been taken off the market.

The inhaler contains a propellant that is damaging the ozone layer. It is called chlorofluorocarbon, or CFC, which is added to get the medicine from the aerosol canister into users' lungs.

The propellant has been banned by the United States Food and Drug Administration because it is responsible for 1/10th of a percent of global CFC emissions.

Those inhalers that are available with a prescription are using hfa propellants, which have replaced CFCs.

Experts say the new propellant is better for the environment, but also for the user, since the dosage is more accurate and less severe to inhale.

The measure may cause people to self-treat asthma and get a real diagnosis of their problems, officials say, but they may have to deal with a hefty price increase.

Source: NBC-2

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