Children who receive high-doses of Flovent and similar asthma inhaler drugs do not appear to show improved asthma symptoms, according to the findings new research.
In a study published this week in The New England Journal of Medicine, researchers indicate that high-doses of asthma medications, like the Flovent inhaler, are commonly prescribed to asthmatic children, but warn that the treatments not only fail to improve symptoms, but may also stunt their growth.
While high-dosing of asthma medications is not endorsed by medication guidelines, doctors often recommend the treatments for children experiencing asthma symptoms.
Researchers from the University of Wisconsin studied 254 children 5 to 11 years of age, who had mild to moderate persistent asthma. They had at least one asthma “exacerbation” treated with systemic glucocorticoids, specifically Flovent, in the year before the study.
An exacerbation was considered an asthma flare up, where symptoms worsened, but was not a full-blown asthma attack. Researchers categorized this as the “yellow zone.” When a child is in the yellow zone, they might need their inhaler more often than usual or have trouble sleeping because of asthma.
Children were treated for 48 weeks with either a maintenance low-dose of Flovent or a dose five times the strength of the maintenance dose. The maintenance dose consisted of 44 mcg per puff of Flovent, two puffs per day. The high dose was quintupled to 220 mcg per puff, two puffs per day.
Researchers indicate that there was no significant difference in the number of severe asthma attacks between the two groups. In fact, each group had similar rates of attacks, 0.48 per year in the high-dose group and 0.37 per year in the low-dose group.
Other factors were also the same, including time to first attack, rate of treatment failure, symptom scores, and albuterol use.
Researchers noted, however, that children in the high-dose group eventually weighed less than those in the low-dose group and grew at a slower rate.
Children in the high-dose group had a growth rate 0.23 cm per year less than those assigned to low-dose group. While the medicine stunted their growth, those children also didn’t see improvement in their symptoms.
Glucocorticoids, which are a class of corticosteroids used to treat asthma attacks, are known to weaken bones and increase infection rates. Yet, the new study points to even more side effects for high doses.
Researchers worry this may stunt a child’s growth long term.
“In children with mild-to-moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose at the early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes and may be associated with diminished linear growth,” the researchers concluded.