Inhaled Corticosteroids and Catch-Up Growth in Children with Asthma

Abstract

In most long-term asthma studies evaluating efficacy and safety of inhaled corticosteroids (ICSs) in prepubertal children the initial phase of treatment has been connected with a decline in height velocity. This has been observed during both high- and low-dose treatment with ICS. The decline in height velocity is often normalized within months of prolonged regular treatment with ICS. The mechanism of this recovery in height velocity is still unknown. Despite the recovery of height velocity, the catch-up of the initial loss of growth would appear to depend on the duration of regular ICS treatment. This catch-up growth has been demonstrated following an initial regular maintenance ICS treatment for children with mild persistent asthma when the ICS is subsequently administered only as-needed. To decrease the systemic exposure to an ICS, the dose should be reduced as soon as asthma is controlled. However, the benefits of ICS outweigh potential adverse effects and the risks associated with poorly controlled asthma. The well-documented decline in drug adherence during prolonged ICS treatment may lead to low doses or even interruptions in ICS administration, and this might go some way to explain the recovery of height velocity and also explain the findings of some long-term studies, where normal adult height is achieved in children receiving ICS therapy for asthma throughout their childhood and into adulthood.