A study of the effects of budesonide for the treatment of asthma should be carefully considered by those of us who treat eosinophilic esophagitis with “topical” steroids; also, this study has applicability to Crohn’s disease patients receiving chronic glucocorticoids. Mean adult height was 1.2 cm lower in the budesonide-treated asthmatics than in the placebo group (NEJM 2012; 367: 904-12).
This was the main finding at the end of the Childhood Asthma Management Program (CAMP) clinical trial. This report examined 943 of 1041 (90.6%) participants who had received either 0.4 mg of budesonide, 16 mg of nedocromil or placebo daily for 4 to 6 years. Treatment with these agents began between ages 5 to 13.
The reduction in adult height was to similar in adulthood as it was after 2 years of treatment; there was not catch up growth. With regard to the adult measurements, 96.8% of the adult women were at least 18 years and the adult men were at least 20 years of age.
Other findings:
- Larger daily dose: each microgram per kilogram was associated with -0.1 cm drop
- Other risk groups: Hispanic ethnic group, female sex, greater body mass index, longer duration of asthma, and higher Tanner stage at initiation
The authors note that 0.2 mg dosage of budesonide has been shown to be effective to control asthma symptoms in children 5-11 years. The “lowest effective dose” should be used; “the effect on adult height must be balance against the large and well-established benefit of these drugs in controlling persistent asthma.”
Related links:
Looking better or feeling better in EoE?
Guidelines for Eosinophilic Esophagitis
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