To Inhale or Not to Inhale Steroids

Another warning -- inhaled steroids can sometimes affect growth in children. Studies in the early 1990s showed that when children begin taking these medications their growth velocity (the rate of growth in millimeters per week) drops just a bit.

Year-long studies have repeatedly shown that over this time frame, a child with asthma who does take steroids will grow on average about one centimeter (1 inch = 2.5 cm) less than a child with asthma who does not take steroids. However, a child with poorly controlled asthma has an even greater risk of suppressed growth. But before we get all bent out of shape over this, science's best estimate is that a child's final adult height may -- and I emphasize may -- be reduced by about half an inch after steroid therapy. This has not been proved, but is understood to be a reasonable estimate of risk. So life-saving steroids may knock off a half inch of final height.

Incidentally, researchers believe that despite this initial slowdown in growth, children with asthma will catch up to their taller peers -- more likely because they receive appropriate treatment with inhaled steroids, not in spite of it.

Weigh Risks, Benefits of Treatment

Ultimately, the decision -- to inhale or not to inhale, so to speak -- boils down to a risk versus benefit analysis, and (conveniently enough) a summarized analysis has come down from the top asthma brass -- a collaboration of the American College of Chest Physicians, the American Academy of Allergy, Asthma, and Immunology, and the American College of Allergy, Asthma, and Immunology.

The preponderance of evidence concludes that the proven clinical effectiveness of inhaled steroid treatment for asthma decidedly outweighs the proven risks. Do not let steroid phobia interfere with your child's well-being.

You want your child to be out there with his or her playmates and not standing dejected at the sidelines.

Dr. Paul Pianosi is a consultant of pediatric pulmonology in the department of pediatric and adolescent medicine at the Mayo Clinic in Rochester, Minn.

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