Can Steroids Stunt My Child’s Growth or Damage My Child’s Lungs?
- Saturday, September 19, 2009, 13:44
- Asthma
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- Andrew:
- Dr. Gower, as we talk to parents and we talk about these different medications, and you mentioned prednisone. You’ve also mentioned the word that we hear in asthma, of course, steroid. And so many of the questions that we get to our Web site are from parents who say, “I am worried about the side effects of these medications. Can they stunt my child’s growth? Can they damage their young lungs?” Maybe you could talk about that for a minute.
- Dr. Gower:
- Okay, I’d be happy to. I always take a very proactive approach to that because I, as you’ve found out, am very aware that everybody’s concerned about steroids. A lot of the athletes use it. It has a bad reputation. There are some particular problems that can develop, and they’re not all good. But with respect to asthma, the steroids – we’re talking about oral steroids now, prednisone, and not the inhaled steroids so much – they can cause some problems with absorption. Long-term inhaled steroids have been also shown over the last couple years, if you take it on a regular basis – and this of course depends on the person and the length of time, the amount of medicine taken – can slow down the growth velocity. We do not know – nobody in the world knows – if this is a permanent reduction in the total eventual growth. So, it can slow it down, but it does not damage the lungs. Conversely, asthma that’s not treated with inhaled steroids to cut down the inflammation may well become damaged just from the asthma. So it’s sort of a two-edged sword here. If you have asthma that’s not controlled with a good anti-inflammatory agent, then the lungs become damaged and scarred. If you have too much medicine, then you can have side effects. So I wouldn’t use the term “worried,” I would be concerned and therefore I would use first of all the approach that I would try to control the disease process.
Once stable, I would always try to lower the amount of steroid. As one of the first approaches in the long-term management, I would try to lower to low or moderate doses of inhaled steroids. There’s very little evidence that that’s going to cause any significant problem. There’s a certain approach that if something’s good, more is better, and that’s not the case. And that’s especially true in the inhaled steroids. You do not get a steady linear improvement as you keep increasing the dose of steroids.
Everybody responds differently to medicines, but generally, after you get a certain dose – it’s usually the moderate or full dose according to the PDR guidelines – you do not get improved benefit from that by increasing or doubling or tripling the dose. If the person is not adequately controlled on that safe, previously studied in many different clinical trials dosage, then other medicines such as the Singulair or the Accolate or the Intal or the Tilade or other kind of controlling medicines should be added to the inhaled steroid.
So the damage to the lungs usually comes from the disease. The side effects of uncontrolled asthma can be growth stunting also. So it’s not just the slowdown of the growth by the steroids; it’s the slowdown of the growth from the disease process because it takes so much energy of the body to fight the disease.
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