Monitor Growth When Using Nebulized Glucocorticoids as an Asthma Treatment in Children
Using a nebulizer as a delivery system for glucocorticoid medication is effective in treating asthma in children, but a National Jewish Medical and Research Center physician recommends continued caution in using the medication because of the drug's possible impact on a child's growth.
For the past 10 years, physicians in the United States have anticipated a Food and Drug Administration-approved glucocorticoid in a nebulized version for children five and younger. (It's been available in Europe for the past several years.) Currently, inhalers are the main way to deliver the medication. Because inhalers are difficult for a child to control, only a very small amount of the drug reaches the lungs. "It's a challenge for children less than three years old," says Stanley J. Szefler, MD, director of Clinical Pharmacology at National Jewish.
Dr. Szefler's editorial accompanies an article about a new glucocorticoid clinical trial, which appears in the Journal of Allergy and Clinical Immunology. The editorial suggests physicians continue to use caution when prescribing a glucocorticoid for a child, especially those under 5 years old, because long-term use, especially with high doses, can suppress growth.
"The movement is to support early diagnosis and intervention of asthma," says Dr. Szefler, who is a member of the Food and Drug Administration Pulmonary-Allergy Drug Advisory Committee. "More information is becoming available for the safe and effective use of inhaled steroids in younger children. In older children and adults, inhaled steroids are recognized as the preferred method for long-term asthma control.
"The newly-published study is one of only a few that have probed the safety and effectiveness of using a nebulizer, a device that suspends medication in a mist that is breathed through a mask, for the delivery of glucocorticoids in children. Glucocorticoids, or corticosteroids, reduce inflammation in the lungs.
This information has been approved by Stanley Szefler, MD (February 2006).
