does child growth recover after Budesonide
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Question:
Re: does child growth recover after Budesonide Has anyone any information on child growth recovery after Budesonide-induced stunting? My 5 year old daughter has been taking Pulmicort (Budesonide) for her asthma for the last 3 years. She looks noticeably shorter than her class-mates at school and her sister (2 years younger) is nearly as tall as her. The dosage was 200mcg per toot through a spacer, but when things were bad she might have 2-3 toots. I have read that a Toronto study looked at side-effects of Budesonide in children over a number of years. They found growth loss among other things. Does anyone know if growth recovers after discontinuing the drug?
Response:
- Hide quoted text — Show quoted text – > Re: does child growth recover after Budesonide > Has anyone any information on child growth recovery after > Budesonide-induced stunting? > My 5 year old daughter has been taking Pulmicort (Budesonide) for her > asthma for the last 3 years. She looks noticeably shorter than her > class-mates at school and her sister (2 years younger) is nearly as tall > as her. > The dosage was 200mcg per toot through a spacer, but when things were > bad she might have 2-3 toots. > I have read that a Toronto study looked at side-effects of Budesonide in > children over a number of years. They found growth loss among other > things. > Does anyone know if growth recovers after discontinuing the drug?
I don’t know if growth would recover, but I suspect not. Children who are on prednisone for Juvenile Rheumatoid Arthritis are very short as adults (of course this could be due to the JRA as well as the steroids). If your daughter is falling off her growth curve (if she was on the 50% track before steroids and is now on the 25% or lower) this needs to be brought to her doctor’s attention and discussed. Could she have a growth hormone deficiency as well? At 5, she still has lots of growing time, but better to have her doctor start following it now rather than wait until she is 11 or 12. Kim
Response:
- Hide quoted text — Show quoted text – > Re: does child growth recover after Budesonide > Has anyone any information on child growth recovery after > Budesonide-induced stunting? > My 5 year old daughter has been taking Pulmicort (Budesonide) for her > asthma for the last 3 years. She looks noticeably shorter than her > class-mates at school and her sister (2 years younger) is nearly as tall > as her. > The dosage was 200mcg per toot through a spacer, but when things were > bad she might have 2-3 toots. > I have read that a Toronto study looked at side-effects of Budesonide in > children over a number of years. They found growth loss among other > things. > Does anyone know if growth recovers after discontinuing the drug?
I have seen reports that a low dose of inhaled steroid (beclomethasone, budesonide), 400 mcg/day, is considered safe in children. That’s 2 puffs/day of the Pulmicort 200. I have also read that if higher doses are required, that a long-acting bronchodilator drug should be added, Serevent (salmeterol) inhaler or theophylline sustained-release (TheoDur) tablets; these are steroid sparing drugs. Here’s a reference on effect of steroids on growth of children: http://www.ama-assn.org/special/asthma/library/scan/attain.htm Excerpt: “Attained Adult Height After Childhood Asthma: Effect of Glucocorticoid Therapy Abstract Background: Although oral and inhaled glucocorticoid therapy may impair growth in children with asthma, the effect of glucocorticoid therapy and asthma on attained adult height has not been extensively studied in representative children in the community. Conclusions: We conclude that the attained adult height of patients with asthma is not different from the adult height of age- and sex-matched nonasthmatic subjects and that the attained adult height of asthmatic children treated with glucocorticoids is not significantly different from the adult height of children not treated with glucocorticoids.” (J Allergy Clin Immunol 1997;99:466-474) Commentary 2 http://www.ama-assn.org/special/asthma/library/scan/ascom15.htm Excerpt: “Commentary by: Mitchell Lester, MD Division of Immunology Children’s Hospital Boston, Mass (Posted August 1, 1997) In this retrospective study from the Mayo Clinic, adult height was examined in 153 individuals with a history of childhood asthma. (1) Overall, there was no difference in adult height in those with asthma compared with age-matched control patients. Patients who had received any form of corticosteroids attained an adult height that was 1.2 cm shorter (a statistically nonsignificant difference) than those who did not receive steroids. Available data do not suggest that rare, short courses of oral steroids affect growth, but there is a great deal of interest in the systemic effects of long-term use of inhaled corticosteroids. As Silverstein et al point out, some studies show short-term reversible growth suppression with inhaled steroid use and others show a lack of catch-up growth. Careful review of the literature suggests that the dose, specific preparation, and dose delivery system (ie, use of a holding chamber) may affect the relative risk of systemic effects of inhaled steroids. (4)” Ellis
Response:
- Hide quoted text — Show quoted text -> > Re: does child growth recover after Budesonide > > Has anyone any information on child growth recovery after > > Budesonide-induced stunting? > > My 5 year old daughter has been taking Pulmicort (Budesonide) for > her > > asthma for the last 3 years. She looks noticeably shorter than her > > class-mates at school and her sister (2 years younger) is nearly > as tall > > as her. > > The dosage was 200mcg per toot through a spacer, but when things > were > > bad she might have 2-3 toots. > > I have read that a Toronto study looked at side-effects of > Budesonide in > > children over a number of years. They found growth loss among > other > > things. > > Does anyone know if growth recovers after discontinuing the drug? > I have seen reports that a low dose of inhaled steroid > (beclomethasone, > budesonide), 400 mcg/day, is considered safe in children. That’s > 2 puffs/day of the Pulmicort 200. I have also read that if higher > doses are required, that a long-acting bronchodilator drug should be > added, Serevent (salmeterol) inhaler or theophylline > sustained-release > (TheoDur) tablets; these are steroid sparing drugs. > Here’s a reference on effect of steroids on growth of children: > http://www.ama-assn.org/special/asthma/library/scan/attain.htm > Excerpt: > “Attained Adult Height After Childhood Asthma: Effect of > Glucocorticoid > Therapy > Here’s a new reference that supports the use of an MDI inhaler: > http://www.ama-assn.org/special/asthma/newsline/reuters/11131432.htm > MDI Drug Delivery Could Curb Growth Problems In Pediatric Asthma > WESTPORT, Nov 13 (Reuters) – The mode of delivery of an inhaled > steroid > influences the risk of growth retardation in asthmatic children, say > UK > researchers in the October issue of the Archives of Diseases in > Childhood. > Dr. N. J. Shaw and colleagues at Birmingham Children’s Hospital note > that it is > difficult to separate the effects of asthma itself on growth in > children from those > of therapies for the disease. They attempt to tease out the > differences and draw > clinical conclusions from a review of recent studies. > Oral corticosteroids clearly “…have a detrimental effect on growth,” > they say. > Some studies suggest the effect is mainly a delay in growth and onset > of > puberty; others show that height may be “permanently reduced” in > children > who take these drugs over the long term. > Contradictory results have been seen with respect to inhaled steroids. > Some > studies show delayed puberty; others show slowed growth rates beyond > what > might be expected for delayed puberty alone. Still others show > dose-dependent > effects on growth; for example, growth reduction was seen with daily > doses of > 800 mcg budesonide but not with 200 or 400 mcg, and with high-dose > fluticasone but not with the recommended dosage of 200 mcg daily. > Other investigations revealed that the mode of administration of the > inhaled > steroid influences the risk of growth retardation. The risk is greater > when the > drug is given with a dry powder inhaler compared with an MDI, > presumably > because the amount of systemically-absorbed drug may be as much as two > times greater with the dry powder formulation. > The Birmingham team conclude there is “…good evidence that inhaled > corticosteroids in high doses can slow growth velocity in some > children with > asthma,” although it is not clear whether the effect is temporary or > affects final > height. On the other hand, they write, clinicians must also be aware > of the > “significant benefits” of these drugs in pediatric asthma. > They recommend that children receive inhaled steroids for asthma in > “…the > dose that controls their symptoms and improves lung function.” Once > asthma is > controlled, the dosage may be reduced. > They also note that if doses of beclomethasone or budesonide greater > than 400 > mcg daily are required, “it is better to give this using a metered > dose inhaler and > large volume spacer than a dry powder inhaler.” If doses of more than > 800 mcg > daily are needed, they suggest switching to fluticasone, which does > not seem to > affect growth at conventional doses. In all cases, growth should be > monitored > on a regular basis.” > Arch Dis Child 1997;77:284-286. >
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