INHALER TERROR

Should your patients be worried about stunting their growth with ongoing use of their puffers?

Click here for previous newsletters.

1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "My friend said the puffer my child is using is a steroid, and that it can prevent my child from growing properly. Is this true?"

Concise Conclusion: Your friend is correct that certain steroid medications can stunt growth. Fortunately, puffers don't make it into the body as much as something like a pill or injection, so I would not be too concerned. The concerning studies show only a difference of less than an inch in growth at the end of the day, which is unlikely to be more important than controlling your child's lung problems.

Quick Wrap-up: Preventing the need for oral corticosteroids and antibiotics for exacerbations will far outweigh any risks to growth posed by an inhaled corticosteroid. Another thing you can do to reassure your patients is offer to switch them to inhalers with lower systemic absorption, such as fluticasone, mometasone, or ciclesonide, the latter being a prodrug. These theoretically would pose a lower risk.

Dive Deeper

1) https://cps.ca/en/documents/position/mild-asthma

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