Inhaled corticosteroids reduce growth. Or do they?

The class label warning in the United States for inhaled corticosteroids (ICS's) states that these drugs may reduce growth velocity in children. In this paper, the evidence for this warning is reviewed from a clinical point of view. Children with asthma tend to grow slower than their healthy peers during the prepubertal years because they go into puberty at a later age. However, asthmatic children do achieve a (near) normal adult height. In randomized controlled clinical trials, the use of inhaled beclomethasone, budesonide and fluticasone is associated with a reduced growth during the first months of therapy, in the order of magnitude of approximately 0.5-1.5 cm x yr(-1). It is, however, unlikely that such an effect continues or persists because accumulating evidence shows that asthmatic children, even when they have been treated with ICS for years, attain normal adult height. Individual rare cases have been reported, however, where ICS use was associated with clinically relevant growth suppression. Inhaled corticosteroids are the most effective therapy available for maintenance treatment of childhood asthma. Fear of reduced growth velocity is based on exceptional cases and not on group data. It should, therefore, not be a reason to withhold or withdraw such highly effective treatment in children with asthma.     

Age Differences In Emotion Recognition: Task Demands Or Perceptual Dedifferentiation?

Background/Study Context: Older adults (OA) have consistently shown lower accuracy compared with younger adults (YA) when labeling facial expressions of emotion in multiple choice tasks. However, OA do not show lower accuracy when judging psychological attributes from faces in rating tasks. The authors investigated whether the cognitive demands of multiple choice tasks yields an underestimation of OA emotion recognition ability and whether lower scores by OA in emotion recognition tasks are an instance of age-related dedifferentiated face perception.

Methods: Younger and older adults judged the emotions of faces depicting various expressions using (a) a multiple choice task and (b) a rating task with separate scales for each expression. We computed both accuracy scores and an emotion differentiation index, adapted from previous work on neural activation to different stimulus categories.

Results: Lower OA performance in emotion recognition do not reflect the cognitive demands of a multiple choice task, since age differences also were shown when assessing emotion expressions on independent rating scales. An index calculating differentiation of the emotion expressions supported the hypothesis that age differences in emotion recognition accuracy may reflect age-related perceptual dedifferentiation.

Discussion: Results are consistent with other evidence for perceptual dedifferentiation in OA, including lower OA performance in face recognition tasks, rating faces more similarly to one another on trait dimensions, and less specificity in neural activation to faces.