The effect of long-term oral steroids on growth in children with cystic fibrosis

Abstract

Background: Previous randomised controlled trials of high dose oral corticosteroids in cystic fibrosis (CF) have reported serious adverse effects including decreased growth. The long term effects of regular low dose oral corticosteroids on growth are less clear. Aims: To describe the long term effects on growth of low dose oral steroids on children with CF. Methods: Case control comparison of growth of subjects receiving regular oral steroids for greater than 6 months, and age and sex matched controls. Height, weight and body mass index (BMI) were collected, and standard deviation scores (SDS) calculated. For each subject the slope of change in height, weight and BMI SDS was calculated by linear regression for 24 months before commencing steroids, and for the period after starting steroids. Results: 28 cases and 28 controls were identified, with no significant differences between the two groups at baseline. Mean duration of follow up data was 4 years for both groups. Mean daily dose of prednisolone was 0.15mg/kg. There were no significant differences in slope of weight or BMI SDS between groups. There was a significant difference in slope of height SDS between the cases and controls after commencing steroids (−0.12 v 0.02 SDS/yr; 95% CI diff −0.24, −0.01; p = 0.032). Growth suppression was greatest in the first year (−0.17 v 0.10 SDS/yr, 95% CI diff −0.47, −0.07; p = 0.008), and there was no significant difference in change in height SDS in the subsequent 2 (−0.06 v −0.10 SDS/yr; p = 0.6) or 4 years (−0.03 v −0.04 SDS/yr; p = 0.9). Conclusions: Use of regular low dose oral steroids in CF has a short term effect on growth, but thereafter growth appears normal.