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N Engl J Med. 2012 Sep 6;367(10):904-12. doi: 10.1056/NEJMoa1203229. Epub 2012 Sep 3.

Effect of inhaled glucocorticoids in childhood on adult height.

Collaborators (286)

Williams P, Lasley MV, Chinn T, Hinatsu M, Furukawa CT, Altman LC, Virant FS, Kennedy MS, Becker JW, Tilles S, MacLaren M, Bierman C, Crawford D, DuHamel T, Eliassen H, Hammond B, Minotti DA, Reagan C, Shapiro G, Sharpe M, Tatum A, White G, Wighton TG, Fuhlbrigge A, Plunkett A, Madden N, Boehnert M, Darcy C, Feins A, Kandror N, MacAulay K, Weiss S, Torda W, Tata M, Babigian S, Barrant P, Benson L, Caicedo J, Calder T, DeFilippo A, Dorsainvil C, Erickson J, Fulton P, Grace M, Gilbert J, Greineder D, Haynes S, Higham M, Jakubowski D, Kelleher S, Koslof J, Mandel D, Martin P, Martinez A, McAuliffe J, Nakamoto E, Pacella P, Parks P, Sagarin J, Seligsohn K, Swords S, Syring M, Traylor J, Van Horn M, Wells C, Whitman A, Grasemann H, Miki M, Solomon M, Subbarao P, MacLusky I, Reisman J, Levison H, Hall A, Benedet Y, Carpenter S, Chay J, Collinson M, Finlayson-Kulchin J, Gore K, Hipolito N, Holmes N, Hoorntje E, Klassen S, Quenneville J, Sananes R, Wasson C, Wilson M, Adkinson N Jr, Bull D, Philips S, Eggleston P, Huss K, Plotnick L, Pulsifer M, Rand C, Aylward E, Bollers N, Pessaro K, Wheeler B, Szefler S, Nelson HS, Bender B, Covar R, Liu A, Spahn J, Sundström D, Phillips M, White MP, Gleason M, Krawiec M, Larsen G, Spears G, Brelsford K, Bridges J, Ciacco J, Eltz M, Feeley J, Flynn M, Junk-Blanchard T, Hassell J, Hefner M, Hendrickson C, Hettleman D, Irvin CG, Kamada A, Nimmagadda S, Sandoval K, Sheridan J, Washington T, Willcutt E, Cardona I, Carel K, Doshi J, Hendershot R, Jacobs J, Jain N, Kang JK, Kruzick T, Leo H, Macomber B, Malka J, Mjaanes C, Prpich J, Stewart L, Song B, Tamesis G, Zeiger RS, Friedman N, Mellon MH, Schatz M, Harden K, Long T, Macaraeg T, Rodriguez E, Rodriguez E, Christensen S, Easton JG, Feinberg M, Galbreath LL, Gulczynski J, Hansen E, Jalowayski A, Jenson E, Lincoln A, Kaufman J, King S, Lopez B, Magiari-Ene M, Mostafa K, Moscona A, Nelle CA, Powers J, Sandoval K, Wilson NW, Kelly H, Jacobs A, Raissy HH, Spicher M, Batson C, Annett R, Archibeque T, Bashir N, Bereket H, Braun M, Bush C, Bush SC, Clayton M, Colon-Semidey A, Devault S, Esparham A, Grad R, Hunt D, Larsson J, McCallum K, McClelland S, McWilliams B, Montoya E, Moreshead M, Murphy S, Ortega B, Weers D, Zayas J, Strunk RC, Bacharier L, Bloomberg GR, Rodgers D, Albers E, Corry JM, DeMuth K, Kertz L, Morgan V, Moseid C, Oliver-Welker T, White DK, Tonascia J, Belt P, Collins K, Collison B, Colvin R, Dodge J, Donithan M, Ewing C, Jackson R, Livingston H, Meinert J, Reyes G, Smith M, Sternberg AL, Van Natta ML, Wagoner A, Wilson L, Wise R, Yates K, Taggart V, Eggers L, Kiley J, Moore H, Zheng G, Albert P, Hurd S, Parker S, Randall P, Wu M, Cloutier M, Connett J, Cuttler L, Gilliland F, Davis CE, Eigen H, Evans D, Kattan M, Menendez R, Simons F, Leikin S, Strunk R, Adkinson N, Annett R, Bender B, Caesar M, Cherniack R, DuHamel TR, Fuhlbrigge A, Grasemann H, Kelly H, Levison H, Lincoln A, MacLusky I, McWilliams B, Meinert CL, Parker S, Reisman J, Rodgers D, Seligsohn K, Shapiro GG, Sharpe M, Sundström D, Szefler S, Taggart V, Tata M, Tonascia J, Weiss S, Wheeler B, Williams P, Wise R, Zeiger R.

Author information

1
University of New Mexico, Albuquerque, USA. hwkelly@salud.unm.edu

Abstract

BACKGROUND:

The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height.

METHODS:

We measured adult height in 943 of 1041 participants (90.6%) in the Childhood Asthma Management Program; adult height was determined at a mean (±SD) age of 24.9±2.7 years. Starting at the age of 5 to 13 years, the participants had been randomly assigned to receive 400 μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years. We calculated differences in adult height for each active treatment group, as compared with placebo, using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry.

RESULTS:

Mean adult height was 1.2 cm lower (95% confidence interval [CI], -1.9 to -0.5) in the budesonide group than in the placebo group (P=0.001) and was 0.2 cm lower (95% CI, -0.9 to 0.5) in the nedocromil group than in the placebo group (P=0.61). A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (-0.1 cm for each microgram per kilogram of body weight) (P=0.007). The reduction in adult height in the budesonide group as compared with the placebo group was similar to that seen after 2 years of treatment (-1.3 cm; 95% CI, -1.7 to -0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in prepubertal participants.

CONCLUSIONS:

The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height, although the decrease was not progressive or cumulative. (Funded by the National Heart, Lung, and Blood Institute and the National Center for Research Resources; CAMP ClinicalTrials.gov number, NCT00000575.).

PMID:
22938716
PMCID:
PMC3517799
DOI:
10.1056/NEJMoa1203229
[Indexed for MEDLINE]
Free PMC Article

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