can long term use of preventer inhaler cause problems?

[mollysmum82]

DD is approaching 2 and has been on the preventer inhaler for about a year now. Before this, every time she had a cold she would end up in A&E on oxygen and nebulisers, struggling to breathe. After this happened once a month for five months or so the consultant prescribed the preventer.

I went for DDs review with the GP today and she said to continue with the preventer which I was happy with. She asked if DD's growth was okay though which worried me - can steroid inhalers have a long term effect on growth? I asked the GP this but she said "don't worry, the chronic breathing illness alternative would be much worse". This I agree with but I'd like to know how much the Beclometasone could effect her growth. DD is very small for her age (9kg at 22 months) and is on the 2nd centile. She was born at 5 pounds (2nd centile), rose to the 50th, then 25th centile and has dropped to the 2nd centile again. I think this coincides with using the preventer inhaler but it could just be that she's more active now and picky with her food. Or that she's destined to be quite petite (me and DH are quite small).

What do others think? The GP said we could try going to one puff a day (we are on two) but if there isn't any side effects and its keeping her breathing problems at bay is there any point?

Thanks so much in advance

Ds1 and 2 are both on preventers. I asked about longterm use of these wrt growth, and he said the current way of thinking was that growth was restricted because the poor sleep that uncontrolled asthma brought about.
Using a preventer puts the child at less risk of complications, and longterm their health will be much better.
We definitely find now that a cold will last a few days, rather than before, when it would affect their asthma and mean a rough two or three weeks with hospital and doctor visits every other day.

There is a risk that corticosteroids will decrease growth but using the inhaled route decreases this risk. On a quick look around, this paper from 2001 suggests that, while growth rate may be decreased for some years, the final adult height is not altered - it just takes longer to get there. In contrast, reduction in growth rate caused by uncontrolled asthma may well affect final adult height.

HTH.

I asked the doctor, that should have been.

You've made me feel so much better I'm actually in tears. Thank you both so much xx

Also meant to say that the dr said that dc do their growing at night, so any I'll health that can mean they sleep badly could affect their growth.

What dose is she on? My understanding is it has to be very high doses to have any long term impact on height.

My DS sounds similar to yours, having had 6 hospital admissions in his 22 months due to asthma and when they got the dose right for him the brown inhaler has made a massive difference, we have only had one admission in the 6 months he has been on 150mg twice a day.

He is small for his age, but not massively so. I would rather have a small but healthier child though and since his asthma has been more stable his weight gain and growth has increased (no shock as he stops eating when ill!)

I have a friend who was on massive doses of steroids for asthma from a young child (way more than a couple of puffs of preventer a day) and her growth was stunted by it. BUT not noticeably so, in that I have other friends who are naturally shorter than she is.

We do monitor growth in children with asthma, but on a standard dose of an inhaled steroid growth problems are very unlikely.

It's more likely that growth would be affected by repeated courses of oral steroids, or by uncontrolled asthma.

Do you have an asthma nurse at your surgery? They can often be a bit more clued up on symptom management than the GP and should be offering a 6-12 month regular review of your daughter.

As purely anecdotal experience - There has been a minor change in growth percentiles for height in dd (4), but compared to the drops in both height and weight whilst she was undiagnosrd/untreated and repeatedly unwell, it is not significant.

Thanks so much for your help, I really appreciate it. She's on Clenil50, so I assume 50mg a puff so 100mg a day? I will check the instructions though and look into speaking to an asthma nurse.