STEROID INHALANT FOR ASTHMA MAY SLOW KIDS' GROWTH

WASHINGTON -- Hundreds of thousands of children with asthma and allergies
find relief, even lifesaving treatment, from inhaled steroids. Now studies
are finding that the drugs also may slow some children's growth, and
doctors are wrestling with what to tell parents.

There is no proof that these children will be shorter adults--their growth
could catch up. Research hasn't lasted long enough to tell, or to predict
that even if final height is stunted, that it would be more than, say, an
inch.

The drugs are critical to many children and have revolutionized asthma
care. So nobody wants youngsters to stop taking them.

At the urging of lung specialists, however, more children than ever before
are inhaling the medicines, starting at earlier ages and lasting throughout
childhood. So the Food and Drug Administration is struggling with how to
explain the possible side effect without unduly alarming people. It also
wants to find out exactly how big a concern it really is.

"We in no way are trying to frighten clinicians or parents," said Dr. John
Jenkins, the FDA's pulmonary drugs chief. The goal is "to promote the
safest use of these drugs."

The FDA wants to put a warning label on the inhaled steroids, saying they
may temporarily slow children's growth, that long-term effects are not
known, and that pediatricians should carefully chart every child patient's
growth.

The agency also is debating how to make manufacturers determine the lowest
effective dose of each drug, because lower doses should mean less risk.

At issue are corticosteroids. They come in a pill form that, if taken for
long periods, is widely known to stunt growth and cause other side effects.
But newer versions that are inhaled or squirted up the nose--sold under a
variety of brand names including Beconase, Flonase, Pulmicort and
Flovent--cause fewer side effects because most of the medicine travels
straight to the lungs or nasal passages, not through the whole body.

They control inflammation in patients with asthma or allergic rhinitis.
Most important, they can prevent damage to the airways that worsens asthma.

New studies show the medicines also can slow children's growth, the FDA
told an advisory committee of lung and growth experts last month.

Children treated for a year were, on average, about half an inch shorter
than expected. A few children, more sensitive to the drugs, were about an
inch shorter, Dr. David Allen of the University of Wisconsin told the
panel.

Half an inch doesn't sound like much, Allen acknowledged. Once children hit
puberty, they might have a growth surge and catch up. The studies didn't
last long enough to tell, or to know if years of treatment starting at
early ages would slow growth more.

Whether the effect is worth worrying about is controversial among doctors,
and manufacturers argue it is just a short-term blip.

"There's little evidence these drugs actually stunt growth," said Dr.
Tushar Shah of Glaxo Wellcome Inc., which makes several of the products.

Last month, FDA's advisers endorsed its proposed warning labels and
frequent growth measurements. The committee emphasized that manufacturers
should study child patients through adulthood to prove whether growth
catches up.

The concern comes at an awkward time. Lung specialists are trying to get
more asthmatics to use the inhaled steroids. They say too few of the 4.8
million child asthmatics are prescribed the medicines, and new federal
guidelines recommend that even people with mild asthma use them daily.

Checked-by: (Joel W. Johnson)