Islamabad - Young children given asthma medication before the age of two may not grow to their full height in later life, a preliminary report suggests. The study of 12,000 Finnish infants found that, on average, those who used inhaled corticosteroids (ICS) long-term showed signs of stunted growth. Previous research has suggested a link with growth suppression.

Experts said the study was a reminder that steroids should be used with caution in pre-school children. However, Asthma UK said inhaled corticosteroids played a crucial in controlling asthma symptoms and reducing trips to hospital for young infants.

The findings are presented at the European Society for Paediatric Endocrinology conference. One in 11 children in the UK has asthma, making it the most common long-term medical condition among children.

Inhaled corticosteroids (ICS) are strong medications commonly found in inhalers, used to treat asthma in adults and recurrent wheezing in children - but they are known to have side-effects in some people. The latest guidelines for GPs recommend that all children taking inhaled steroids for asthma should have their height and weight checked every year for any signs of reduced growth.

Lead researcher Dr Antti Saari, from the University of Eastern Finland, said his team had analysed information on the height of the children’s parents, as well as data on the children’s weight and asthma medicine, to calculate expected height and growth. He found an association which, if permanent, could lead to around 3cm of decreased adult height. Dr Saari said: “It is important that doctors think twice whether these steroids are needed or not in this age group.” Jonathan Grigg, honorary medical adviser to the British Lung Foundation and professor of paediatric respiratory medicine at Queen Mary University London, said treating very young children who were wheezing was not easy.

“We haven’t worked out who responds to steroid treatment in this group. In young pre-school children who wheeze, it is unclear which ones should be targeted with steroids. Many grow out of asthma and won’t need further treatment.” He said a larger study of different groups of younger children was needed to find out more. Dr Samantha Walker, director of research and policy at Asthma UK, said inhaled corticosteroids were crucial for reducing and controlling asthma symptoms and the impact on height was “relatively minor”.

She added: “No parent should stop their children taking these life-saving medicines, because a slight reduction in growth is a small price to pay for medicines which may save your child’s life.”

Could a pill offer the same benefits

as exercise?

It is well established that exercise is good for health. But would you still head to the gym if you could simply take a pill that produces some of the same benefits? According to a new report, such an option may not be too far off.

Researchers say it is feasible that a pill could one day replace exercise.

Regular exercise can lower the risk of obesity, diabetes and heart disease, as well as numerous other conditions. In July, Medical News Today reported on a study linking exercise in adolescence to reduced risk of cancer and all-cause mortality in women.

In the journal Trends in Pharmacological Sciences, Ismail Laher, of the University of British Columbia in Vancouver, Canada, and Shunchang Li, of Beijing Sport University in China, claim increased understanding of the molecular pathways by which exercise benefits the body means an “exercise pill” is feasible.

“Regular physical exercise activates a number of molecular pathways in whole organ systems and reduces the risk of developing numerous chronic diseases,” the authors explain. “The signaling molecules activated by physical exercise are logically considered to be potent pharmacological targets for such exercise pills.”

For their study, Laher and Li set out to review a number of exercise pills that are currently in development and investigate the challenges the creators of these drugs face.

One drug that could be an exercise-mimicking candidate is AICAR, which works by activating a protein called AMPK.

AMPK plays a key role in maintaining the body’s energy balance, and it also interacts with PGC-1x - a protein that the researchers say “induces mitochondrial biogenesis and fiber-type transformation in skeletal muscles.”

“Thus, treatment with AICAR activates AMPK, and AMPK then interacts, either directly or indirectly, with PGC-1x, inducing improved oxidative metabolism, mitochondrial biogenesis, and fiber-type transformation in skeletal muscle,” they explain. “Taken together, this suggests that AICAR is capable of mimicking a broad spectrum of exercise-like adaptation in skeletal muscle.”

Another exercise pill in development is GW501516 - a drug first developed by GlaxoSmithKline (GSK) in 1992 for use as a potential treatment for metabolic syndrome. More recently, it was found the drug activates a form of the hormone receptor PPAR, which triggers physiological properties often seen in response to exercise.

In July, MNT reported on another candidate for an exercise pill that Laher and Li review in their report, called compound 14. Developed by researchers from the UK’s University of Southampton, the drug works by blocking an enzyme called ATIC, which, in turn, activates the all-important AMPK protein.

“There is a lot of evidence from previous studies that if you could selectively activate AMPK with a small molecule, it could have potential benefits in the treatment of several diseases, including type 2 diabetes, by acting as an exercise mimetic and increasing the uptake and usage of glucose and oxygen by cells,” explains creator of compound 14, Ali Tavassoli.

“Our molecule, which activates AMPK by altering cellular metabolism, therefore holds much promise as a potential therapeutic agent,” he adds. Laher and Li admit it is clear there is a long way to go before exercise pills achieve clinical application. More research is needed to determine their safety and efficacy, as well as the possibility for misuse - in athletes, for example.

“However, we expect that as we gain an improved understanding of the molecular mechanism by which exercise induces beneficial effects, we will likely gain increased confidence in creating exercise pills that have minimal side effects with much-improved efficacy,” they add.