Question 2: What are the effects of inhaled corticosteroids on growth in children?

Abstract

This review summarizes the current evidence regarding the effects of inhaled corticosteroids (ICS) on growth in children with asthma. The evidence from randomized trials showed a mean reduction of −0.48 cm/year (95% CI −0.65 to −0.30) in linear growth velocity and of −0.61 cm (95% CI −0.83 to −0.38) in height during a one-year treatment with ICS. Some first-generation drugs had a slightly larger suppressive effect on growth than newer drugs, with a mean reduction in linear growth velocity of −0.91, −0.59, −0.08 and −0.39 cm/year for beclomethasone, budesonide, ciclesonide and fluticasone, respectively. There was evidence of a dose–response relationship, with medium doses (HFA-beclomethasone or equivalent, 100 to 200 μg/day) producing a greater reduction than low doses (50–100 μg/day), in height, but not in linear growth velocity. ICS-induced growth suppression was less pronounced during subsequent years of treatment.Most “real life” observational studies did not show significant suppressive effects of ICS on long-term growth or adult height, and some studies found an initial growth reduction related to ICS which did not persist in subsequent years. It remains unclear to what extent long-term ICS use in childhood has an effect on final adult height. I appears that the deleterious effects of ICS on adult height, if any, are small (max 1.2 cm).In conclusion, use of ICS in prepubertal children with asthma is associated with a small but dose-dependent depression in growth in the first year of treatment, but no clinically relevant effect on adult height.