Effect of Inhaled Corticosteroids on Growth and Puberty in Egyptian Asthmatic Children and Adolescents

Abstract

Growth suppression and delayed puberty may be major concerns for Inhaled Corticosteroids (ICS) treatment in children. Thus, we aimed to assess the effect of long-term ICS on growth and pubertal status in 30 asthmatic children and adolescents in comparison to 20-matched healthy subjects. Auxological measurements, Tanner staging and bone age assessment were performed. Measurements of basal and Lutenizing hormone releasing hormone (LHRH) stimulated follicle stimulating hormone (FSH) and Lutenizing hormone (LH) were done for patients only. In addition, pelvic ultrasound for measurements of uterine length and right ovarian volume was done for females aged > 11 years. Patients' height, bone age and their Standard Deviation Scores (SDSs) were significantly lower, while weight SDSs were significantly higher than controls. ICS at doses > 400 microg/day negatively affected height and its SDS (OR: 8.5, 95% CI: 2.15-33.8), whereas the use of ICS for > 1 year significantly affected all auxological parameters with a particular risk on height SDS (OR: 9, 95% CI = 3.10-10.64) and weight for height SDS (OR: 6.82, 95% CI: 1.36-34.27). Significantly lower stimulated gonadotropins were encountered at doses > 400 microg/day, while a duration > 1 year was associated with significantly lower basal and stimulated gonadotropins. Logistic analysis revealed that the use of ICS for > 1 year carried the highest risk of association with low stimulated FSH (OR: 5.80, 95%, CI: 1.54-33.70) and LH (OR: 8.31, 95% CI: 1.83-50.47). In conclusion, ICS at doses > 400 microg/day carry a significant risk of retarding height of asthmatic children while their continuous use for > 1 year carries significant risks of short stature, weight gain and delayed puberty.