https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61693-6.pdf

What works? Interventions for maternal and child undernutrition and survival.

Asthma is the leading chronic disease among children in most industrialized countries. However, the evidence base on specific aspects of pediatric asthma, including therapeutic strategies, is limited and no recent international guidelines have focused exclusively on pediatric asthma. As a result, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams to find a consensus to serve as a guideline for clinical practice in Europe as well as in North America. This consensus report recommends strategies that include pharmacological treatment, allergen and trigger avoidance and asthma education. The report is part of the PRACTALL initiative, which is endorsed by both academies.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1398-9995.2007.01586.x

Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report

Inhaled glucocorticosteroids have now become first-line therapy for the treatment of chronic asthma in many countries. They are the most effective asthma therapy currently available, and numerous studies have documented their long-term efficacy in asthma control in adults and in children. Inhaled steroids suppress inflammation in asthmatic airways, although their precise molecular mechanism of action is not yet certain. It is likely that steroids affect the transcription of several steroid-responsive genes, and, of particular importance, they may inhibit cytokine gene transcription and cytokine effects, thereby reducing the chronic inflammation in asthmatic airways. Inhaled steroids are now used at a much earlier stage in asthma therapy, and there is a strong argument for their early introduction in both adults and children to prevent asthma morbidity and mortality and possibly the structural changes resulting from uncontrolled chronic inflammation, which may lead to irreversible airflow obstruction in so...

Efficacy and safety of inhaled corticosteroids in asthma

Height and weight were measured every six months in a long term prospective study of 66 children with chronic perennial asthma for a mean 13.1 years. There was no evidence of growth retardation on entry into the study. Growth developed along normal lines in all 66 children until about 10 years, and in 35 of these children growth continued along normal lines throughout the whole period of follow up. Thirty children showed the physiological decelerating growth velocity pattern seen in children with delay in the onset of puberty, and one child had an early menarche. The tendency for delay in the onset of puberty was significant for both boys and girls and was noted to be independent of severity of asthma. Once puberty finally began in these children, complete catch up growth resulted in the attainment of the predicted adult height. Long term prophylactic inhalation of beclomethasone dipropionate in 26 children in a dosage up to 600 mcg/day before puberty and 400 mcg/day during puberty was shown not to affect growth. It is concluded that asthma had no direct influence on growth in height but was associated with delay in the onset of puberty. The pre-adolescent physiological deceleration of growth velocity that occurs in these children gives the impression of growth retardation.

https://adc.bmj.com/content/archdischild/61/11/1049.full.pdf

Growth and childhood asthma.

Background: Although oral and inhaled glucocorticoid therapy may impair growth in children with asthma, the effect of glucocorticoid therapy and asthma on attained adult height has not been extensively studied in representative children in the community. Objectives: The study was designed to compare the attained adult height of children with asthma with the attained adult height of nonasthmatic children and to compare the attained adult height of asthmatic children treated with glucocorticoids with the attained adult height of asthmatic children who did not receive glucocorticoids. Methods: Residents of Rochester, Minnesota, with onset of asthma from 1964 to 1987 and age- and sex-matched nonasthmatic residents of Rochester were studied. Glucocorticoid exposure was assessed from medical records. The mean of 5 stadiometer measurements of adult height, adjusted for sex and parental height, was analyzed. Results: One hundred fifty-three patients with asthma (mean age at onset, 6.1 ± 4.8 years) and 153 age- and sex-matched nonasthmatic subjects were studied. Adult height of patients with asthma (mean age at measurement, 25.7 ± 5.2 years) was not significantly different from the adult height of nonasthmatic subjects; the overall difference, adjusted for mid-parental height, was –0.20 cm (95% confidence interval from –0.27 to 1.64). The adult height of asthmatic children treated with glucocorticoids was not significantly different from the adult height of patients with asthma not treated with glucocorticoids; the difference after adjusting for mid-parental height was –0.2 cm (95% confidence interval from –0.1 to 0.6). Conclusions: We conclude that the attained adult height of patients with asthma is not different from the adult height of age- and sex-matched nonasthmatic subjects and that the attained adult height of asthmatic children treated with glucocorticoids is not significantly different from the adult height of children not treated with glucocorticoids. (J Allergy Clin Immunol 1997;99:466-74.)

https://www.jacionline.org/article/S0091-6749(97)70072-1/pdf

Attained adult height after childhood asthma: Effect of glucocorticoid therapy

The effects of asthma per se and of various oral steroid-treatment schedules on linear growth in 231 children with chronic severe asthma (6.2-16.2 years of age) were evaluated. Asthmatic children who had never received steroids and those who received occasional steroids, had comparable growth retardation, averaging approximately 1 standard deviation (s.d.) below their age- and sex-specific predicted means. Children who had been treated for 2 years or longer with alternate-day or daily steroids also did not differ from each other, with both groups averaging approximately 2 s.d. below their predicted means. Growth stunting, intermediate in severity, was found in children treated with frequent intermittent steroids. For groups with steroid medication-histories of never, occasional, intermittent, alternate-day and daily, the percentage of children with 2 or more s.d. below their predicted heights were 25, 17.4, 28, 50 and 45.5 respectively. The duration and dosage of daily steroid-treatment correlated positively with severity of growth retardation. In addition to norms, the children were also compared with a healthy, same-sex sibling and with predictions from their parents' heights. Regardless of the comparison used, the results were similar. Since genetic and socio-economic factors are controlled by the latter two comparisons, the data indicate that these factors played no role in growth retardation in these children. Growth retardation in asthma appears to be due to the disease itself, and is accelerated by steroid therapy.

H. Chai

Papers

Linear growth of chronic asthmatic children: the effects of the disease and various forms of steroid therapy