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Growth in Children Using Glucocorticoids as an Asthma Treatment

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Using a nebulizer as a delivery system for glucocorticoid medication is effective intreating asthma in children, but a National Jewish Health physicianrecommends continued caution in using the medication because of thedrug's possible impact on a child's growth.

For the past 10 years, physicians in the United States haveanticipated a Food and Drug Administration-approved glucocorticoid in anebulized version for children five and younger. (It's been availablein Europe for the past several years.) Currently, inhalers are the mainway to deliver the medication. Because inhalers are difficult for achild to control, only a very small amount of the drug reaches thelungs. "It's a challenge for children less than three years old," says Stanley J. Szefler, MD former 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 whenprescribing a glucocorticoid for a child, especially those under 5years old, because long-term use, especially with high doses, cansuppress growth.

"The movement is to support early diagnosis and intervention ofasthma," says Dr. Szefler, who is a member of the Food and DrugAdministration Pulmonary-Allergy Drug Advisory Committee. "Moreinformation is becoming available for the safe and effective use ofinhaled 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 amask, 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).