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[Inhaled corticosteroids and growth]
M Le Bourgeois1, J de Blic, P Scheinmann
1Service de pneumologie et d'allergologie pédiatriques, hôpital Necker, Paris, France.
Insights
Inhaled corticosteroids (ICS) are effective for asthma but may affect growth. Moderate ICS doses are generally safe for children, with monitoring and proper inhalation techniques recommended.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Pharmacology
Context:
- Asthma management in children, including infants, frequently involves inhaled corticosteroids (ICS).
- Concerns exist regarding the impact of ICS on statural growth in pediatric asthma patients.
- Asthma itself can independently influence a child's growth trajectory.
Purpose:
- To evaluate the safety and efficacy of inhaled corticosteroids in pediatric asthma, focusing on statural growth.
- To clarify the relationship between ICS dosage, asthma severity, and potential growth impairment.
- To provide guidance on optimal asthma management strategies in children.
Summary:
- Inhaled corticosteroids effectively reduce airway inflammation in pediatric asthma.
- Most studies indicate that growth impairment is dose-dependent, with moderate ICS doses considered safe.
- Monitoring growth and avoiding overtreatment are crucial; alternative therapies or proper inhalation techniques are preferred over high-dose ICS.
Impact:
- Informed clinical practice regarding ICS use in pediatric asthma.
- Improved management strategies balancing asthma control and growth monitoring.
- Reduced concerns about ICS side effects when used appropriately in children.
Abstract:
Inhaled corticosteroids are effective in patients with asthma by reducing the chronic inflammatory changes. They are widely prescribed in children and even in infants. The potential adverse effects of inhaled corticosteroids on statural growth have been the matter of numerous past and present controversies. Asthma itself can delay growth. The majority of studies demonstrate that the growth impairment is dose-dependent and that moderate doses of inhaled corticosteroids are safe. Monitoring statural growth of asthmatic children, whether they are treated or not with inhaled corticosteroids is mandatory. The treatment must be adapted to the severity of asthma, and overtreatment must be avoided. Inhalation techniques minimizing systemic absorption must be used. Addition of other antiasthmatic drugs to moderate doses of inhaled corticosteroids should be preferred to high doses of inhaled corticosteroids alone.