Abstract
BackgroundLong-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth.MethodsWe initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic.ResultsWe found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65).ConclusionUse of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.
Highlights
Inhaled corticosteroids (ICS) are amongst the most important treatment options in persistent asthma because of their efficacy in suppressing the inflammatory response
Meta-analysis of 16 randomized controlled trials (RCTs) showed that inhaled corticosteroids (ICS) use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year)
Final adult height showed a mean reduction of -1.20 cm with budesonide versus placebo in a high quality RCT
Summary
Inhaled corticosteroids (ICS) are amongst the most important treatment options in persistent asthma because of their efficacy in suppressing the inflammatory response. [1, 2] there have been widespread, longstanding concerns regarding adverse events (such as fractures, and reduction of growth in children) with corticosteroids. One of the major areas of concern and uncertainty is the potential for reduction in growth velocity and final height of children who are long-term users of inhaled corticosteroids (ICS). In 2006, Pedersen conducted a systematic review on randomized controlled trials (RCTs) of > 12 months ICS use in children, and concluded that there was possibly a small decrease in statural growth. [8] we aimed to analyse the effects of long-term (>12 months) ICS use in children with asthma, concentrating on growth velocity and final adult height in randomized and non-randomized studies. Long-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth
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