Monitor Growth When Using Nebulized Glucocorticoids as an Asthma Treatment in Children
Using a nebulizeras a delivery system for glucocorticoid medication is effective in
treating asthma in children, but a National Jewish Health 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 Health.
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 J. Szefler, MD
(February 2006).
