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Inhaled corticosteroids reduce growth. Or do they?

P L Brand1

  • 1Isala Klinieken/Weezenlanden Hospital, The Netherlands.

The European Respiratory Journal
|May 4, 2001
PubMed
Summary

Inhaled corticosteroids (ICS) may slightly slow growth in children with asthma initially. However, long-term studies show children treated with ICS generally achieve normal adult height, making ICS a vital asthma treatment.

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Area of Science:

  • Pediatric Pulmonology
  • Pharmacology
  • Clinical Medicine

Background:

  • Children with asthma often exhibit slower prepubertal growth due to delayed puberty.
  • A United States class label warning suggests inhaled corticosteroids (ICS) may reduce growth velocity in children.
  • Asthmatic children typically achieve near-normal adult height despite growth variations.

Purpose of the Study:

  • To review clinical evidence regarding the association between inhaled corticosteroids and growth velocity in children.
  • To evaluate the clinical significance of growth suppression warnings for ICS in pediatric asthma management.

Main Methods:

  • Review of clinical evidence and randomized controlled trials concerning ICS use in children.
  • Analysis of growth data from studies involving inhaled beclomethasone, budesonide, and fluticasone.
  • Assessment of long-term growth outcomes in asthmatic children treated with ICS.

Main Results:

  • Randomized controlled trials show a modest, temporary reduction in growth velocity (0.5-1.5 cm/year) during early ICS therapy.
  • Accumulating evidence indicates that long-term ICS treatment does not prevent children from reaching normal adult height.
  • Rare individual cases of clinically significant growth suppression associated with ICS have been reported.

Conclusions:

  • The fear of ICS-induced growth suppression is based on rare exceptions, not group data.
  • Inhaled corticosteroids are the most effective maintenance therapy for childhood asthma.
  • Concerns about growth should not deter the use of essential ICS treatment in asthmatic children.

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