Letter

Higher dose inhaled steroids in childhood asthma

BMJ 2001; 322 doi: 10.1136/bmj.322.7301.1546 (Published 23 June 2001)
Cite this as: BMJ 2001;322:1546.1

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Conventional doses do have side effects

  1. Hayley Archer, specialist registrar,
  2. Kate Creese, specialist registrar,
  3. Iolo Doull, consultant respiratory paediatrician (Doullij@cf.ac.uk)
  1. Cystic Fibrosis/Respiratory Unit, University Hospital of Wales, Cardiff CF14 4X
  2. Manor View Practice, Bushey, Hertfordshire WD23 2NN

    EDITOR—We disagree with Keeley's assertion that in childhood asthma “important adverse effects are rare” with inhaled corticosteroids at doses of ≤400 μg/day (beclomethasone equivalent).1 Growth suppression is the most important side effect of inhaled corticosteroids in childhood, and all three preparations licensed for use in children in the United Kingdom cause appreciable suppression at these doses. A recent meta-analysis reported growth suppression of 1.51 cm/year in children receiving beclomethasone and 0.42 cm/year for fluticasone,2 and the child asthma management programme (CAMP) study showed growth suppression of 1.1 cm/year with budesonide.3

    We agree with Keeley's suggestion that higher doses of inhaled corticosteroids than are currently advocated …

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