Behavioral Side Effects of Medications Used to Treat Asthma and Allergic Rhinitis
Henry Milgrom MD1
Bruce Bender PhD2
1 Associate Professor of Pediatrics
2 Associate Professor of Psychiatry, National Jewish Center for Immunology and Respiratory Medicine and the University of Colorado Health Sciences Center, Denver, CO.
Parents, teachers, and physicians are concerned that medicines may alter children's mood, behavior, and ability to learn. In clinical practice, adverse reactions to drugs and the perceptions associated with them influence prescribing patterns and undermine compliance. In the treatment of chronic disorders such as asthma, where successful management requires that patients take medications consistently over prolonged periods of time, factors affecting compliance become profoundly important.
Asthma medications have been associated with behavioral, affective, and neuropsychological changes in children. Oral corticosteroids exacerbate depression and impair verbal memory, and there are anecdotal reports of severe reactions to inhaled steroids among children, including psychotic behavior. Oral beta agonists have been reported to cause psychotic reactions in adult patients. In children, inhaled albuterol frequently induces a short-term hand tremor, but does not compromise more complex psychomotor functions. Theophylline improves concentration and results in slightly increased hand tremor and feelings of anxiety.
Medicines for allergic rhinitis and those used for cough and colds frequently are administered by parents without the supervision of physicians. Many of these preparations, given not only to children who have allergic disease but also to those who have self-limiting respiratory symptoms, are available over the counter (OTC). This confusing array of combination antihistamines, decongestants, expectorants, and anticholinergic agents constitutes the largest group of drugs taken by children.
