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‘Increasing asthma inhaler strength does not prevent serious attacks, may stunt growth’

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An extra-strong dose of asthma medication given to children to help control their condition does nothing to prevent serious attacks and could even stunt their growth, experts have warned.

Scientists found that children moved to a higher dose of their steroid inhaler when their symptoms showed they were likely to suffer a serious exacerbation of their condition, suffered no fewer attacks than children who kept their regular dose.

The study was published in the New England Journal of Medicine (NEJM).

More worryingly, these children were shown to have grown more slowly than those whose dose was not increased, growing 0.23cm per year less on average, and were exposed to more harmful steroids.

“Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children,” said study lead Dr Daniel Jackson, associate professor of paediatrics at the University of Wisconsin School of Medicine and Public Health.

“But these findings suggest that a short-term increase, to high-dose inhaled steroids, should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids.”

Temporary high-dose steroids are recommended by Global Asthma Initiative guidance, and are used by doctors in the UK and US, particularly for school age children who might not have strategies for controlling their asthma without medication.

Worsening asthma symptoms can signal a serious exacerbation could be coming, and while higher steroid exposure can have long-term effects it is thought to be worth it to prevent a serious attack.


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