Growth rate of children with intractable asthma: Observations on the influence of the illness and its therapy with steroids

Abstract

Anthropometric data were collected on 302 intractable asthmatic children, 6 to 16 years of age, observed at the Jewish National Home for Asthmatic Children in Denver, from July 1, 1958, to Dec. 31, 1960. Admission heights of 83 per cent of these children fell below the mean, or the fiftieth percentile, for their respective age and sex and, in 20 per cent or 10 times more than normal, the heights were more than two standard deviations below the mean. Weights generally corresponded with heights. Bone age, paralleled the heights rather than the chronological age, although a fairly wide range of values was noted. The size of parents did not seem to be primarily responsible for the observed growth deficit among asthmatic children. A review of the individual pre-admission histories indicated that an earlier onset of asthma or a longer duration of the illness was not associated with a significantly greater degree of growth retardation. A history of continuous administration of anti-inflammatory steroids before admission was more common among the smaller children, while shorter courses of steroids, not exceeding 50 per cent of any year of life, did not seem to affect growth adversely. During the 18 to 24 months of residence at the Home, the presence of asthmatic symptoms did not diminish height increments, neither did brief courses of steroids affect growth. Continuous maintenance steroid therapy, given only in severe cases of asthma uncontrollable by other means, was associated with a significantly reduced linear growth rate. A comparison of the growth suppressing effect of prednisone and cortisone indicated that children requiring mean daily doses of prednisone, exceeding 6 mg. per square meter of body surface, exhibited reduced lineal growth rates. On the contrary, children receiving cortisone, in mean daily doses exceeding 50 mg. per square meter, exhibited normal growth increments. The control of asthma, however, seemed to be less satisfactory with cortisone than with prednisone, in what are considered equivalent amounts. A considerable individual variation was noted in growth rates among children in all categories and especially among the adolescents. Preliminary results of pituitary function assays, by means of serum sulfation factor activities, are reported, and the need for additional studies is emphasized.