Asthma, Steroids, and Growth

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http://www.mercola.com/2000/oct/15/steroids_growth.htm

 

Asthma, Steroids, and Growth

 

Editorial

 

Long-term administration of systemic steroids is a cause of impaired growth. (1)

Trials comparing inhaled steroid preparations with other treatment regimens in

nearly 600 children with asthma found that, children treated with inhaled

steroids had less growth in height (1 to 1.6 cm [23 to 27 percent] less) than

those assigned to other treatments.

 

The mechanisms by which this delay in growth occurs are unknown. If inhaled

steroids are not discontinued, does growth suppression continue, so that

children with asthma who are at the 50th percentile for height at the age of six

years fall to the 25th percentile by the time they are adults?

 

Two articles in this issue of NEJM report a reduction of about 20 percent in

growth velocity during the first year of treatment.

 

One caveat is that their may be impairment of the growth of other organs, such

as the brain (9) and the lung. The number and branching structure of airways and

conducting vessels are complete in early gestation, whereas alveoli are formed

in the last months of gestation and during the first years of postnatal life.

The number of alveoli increases by a factor of about six after birth, mostly in

the first two years. Formation of alveoli is complete by the age of five to

eight years. (10,11) Thereafter, the lung grows by increasing the size of

airways and alveoli already present.

 

Until more is known about the influence of steroids on the development of the

lung and other organs, and until better tools are developed to assess organ

growth, it may be prudent to avoid the use of inhaled corticosteroids in young

children with mild asthma.

 

The sparseness of the data on the influence of steroids on organ development

cautions against extending the beneficial findings of the studies of Agertoft

and Pedersen and the Childhood Asthma Management Program Research Group to young

children, particularly those with relatively mild disease.

 

The New England Journal of Medicine -- October 12, 2000 -- Vol. 343, No. 15

 

DR. MERCOLA'S COMMENT: Well here we have it an editorial in NEJM that documents

the danger of using steroids for the treatment of asthma in children. I

understand that this can be a terminal illness in many children, but does that

mean we need to put them on such a potent hormone influencing drug?

 

There are many other options. Normalizing the immune response is a straight

forward process. Changing the diet with special attention to drinking one quart

of pure water daily for every 50 pounds of body weight and normalizing the

immune response to inhaled allergens like mold normalizes most all of the cases

of asthma that I have ever seen.

 

My current favorite is use of a form of muscle testing called Total Body

Modification (TBM). Many have heard of NAET which is derived from TBM. It is my

belief and experience that TBM is a far more profound and effective technique to

correct the underlying disorder.

 

References:

 

1. Davis PB, Kercsmar CM. Growth in children with chronic lung disease. N Engl J

Med 2000;342:887-8.

 

2. Tinkelman DG, Reed CE, Nelson HS, Offord KP. Aerosol beclomethasone

dipropionate compared with theophylline as primary treatment of chronic, mild to

moderately severe asthma in children. Pediatrics 1993;92:64-77.

 

 

3. Doull IJM, Freezer NJ, Holgate ST. Growth of prepubertal children with mild

asthma treated with inhaled beclomethasone dipropionate. Am J Respir Crit Care

Med 1995;151:1715-9.

 

 

4. Simons FER, Canadian Beclomethasone Dipropionate-Salmeterol Xinafoate Study

Group. A comparison of beclomethasone, salmeterol, and placebo in children with

asthma. N Engl J Med 1997;337:1659-65.

 

 

5. Verberne AAPH, Frost C, Roorda RJ, van der Laag H, Kerrebijn KF. One year

treatment with salmeterol compared with beclomethasone in children with asthma.

Am J Respir Crit Care Med 1997;156:688-95.

 

 

6. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide

on adult height in children with asthma. N Engl J Med 2000;343:1064-9.

 

 

7. The Childhood Asthma Management Program Research Group. Long-term effects of

budesonide or nedocromil in children with asthma. N Engl J Med 2000;343:1054-63.

 

 

8. Luo ZC, Low LCK, Karlberg J. A comparison of target height estimated and

final height attained between Swedish and Hong Kong Chinese children. Acta

Paediatr 1999;88:248-52.

 

 

9. Matthews SG. Antenatal glucocorticoids and programming of the developing CNS.

Pediatr Res 2000;47:291-300.

 

 

10. Reid LM. Lung growth in health and disease. Br J Dis Chest 1984;78:113-34.

 

 

11. Brody JS, Thurlbeck WM. Development, growth, and aging of the lung. In:

Handbook of physiology. Section 3. The respiratory system. Vol. 3. Mechanics of

breathing, part 1. Bethesda, Md.: American Physiological Society, 1986:355-86.

 

 

12. Muglia LJ, Bae DS, Brown TT, et al. Proliferation and differentiation

defects during lung development in corticotropin-releasing hormone-deficient

mice. Am J Respir Cell Mol Biol 1999;20:181-8.

 

 

13. Carson SH, Taeusch HW Jr, Avery ME. Inhibition of lung cell division after

hydrocortisone injection into fetal rabbits. J Appl Physiol 1973;34:660-3.

 

 

14. Massaro GD, Massaro D. Formation of alveoli in rats: postnatal effect of

prenatal dexamethasone. Am J Physiol 1992;263:L37-L41. [Errata, Am J Physiol

1992;263:section L following table of contents, 1993;264:section L following

table of contents.]

 

 

15. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first

six years of life. N Engl J Med 1995;332:133-8.

 

 

 

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