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[Inhalation corticosteroids and the growth of asthmatic children]
P L Brand1, J J Hendriks, A A Vaessen-Verberne
1Isala klinieken, Zwolle. p.l.p.brand@isala.nl
Insights
Inhaled corticosteroids (ICS) may reduce growth in children with asthma, particularly beclomethasone. Careful monitoring is essential, and ICS use should be reconsidered if growth slows significantly.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Context:
- Asthma management in children frequently involves inhaled corticosteroids (ICS).
- Previous studies indicated potential growth reduction with certain ICS.
- Individual factors like inhaler device and technique influence systemic absorption.
Purpose:
- To evaluate the impact of different inhaled corticosteroids (ICS) on growth in asthmatic children.
- To identify specific ICS or dosages associated with growth retardation.
- To establish monitoring guidelines for growth during ICS therapy.
Summary:
- Beclomethasone (400 mcg/day) was associated with approximately 1 cm/year growth reduction in asthmatic children.
- Long-term studies with budesonide (400-800 mcg/day) or fluticasone (100-200 mcg/day) did not show significant growth retardation.
- Most children achieve catch-up growth, reaching normal adult height.
- Growth reduction, if it occurs, is most prominent in the first three months of treatment.
Impact:
- Highlights the need for careful growth monitoring in children using ICS.
- Suggests reconsidering ICS therapy if growth velocity decreases by >0.25 SDS within a year.
- Emphasizes the importance of pediatric consultation for managing ICS-related growth concerns.
Abstract:
During therapy with inhaled corticosteroids (ICS) of asthmatic children studies examining growth over several weeks using a knemometer showed a dose-dependent reduction of lower leg growth. During maintenance treatment with beclomethasone 400 micrograms/day for several months the growth of asthmatic children was reduced by approximately 1 cm/year compared with contemporaries who had not been treated with this substance. No such growth retardation was found in studies on long-term therapy with budesonide (400-800 micrograms/day) or fluticasone (100-200 micrograms/day). However, differences between ICS are difficult to establish or to exclude, since the systemic availability may vary, due for instance to the properties of the inhaler and the individual inhaling technique. It appears that most children with asthma treated with ICS perform a catch-up growth so that they reach a normal height as young adults. Since growth retardation if any mostly occurs during the first three months of the treatment, growth of asthmatic children must be monitored carefully. When growth is reduced by > 0.25 standard deviation score within 1 year, the use of ICS needs to be reconsidered. This decision can best be made by a paediatrician or after consulting one.