Inhaled corticosteroids reduce growth. Or do they?
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1Isala Klinieken/Weezenlanden Hospital, The Netherlands.
Insights
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.
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.
Abstract:
The class label warning in the United States for inhaled corticosteroids (ICS's) states that these drugs may reduce growth velocity in children. In this paper, the evidence for this warning is reviewed from a clinical point of view. Children with asthma tend to grow slower than their healthy peers during the prepubertal years because they go into puberty at a later age. However, asthmatic children do achieve a (near) normal adult height. In randomized controlled clinical trials, the use of inhaled beclomethasone, budesonide and fluticasone is associated with a reduced growth during the first months of therapy, in the order of magnitude of approximately 0.5-1.5 cm x yr(-1). It is, however, unlikely that such an effect continues or persists because accumulating evidence shows that asthmatic children, even when they have been treated with ICS for years, attain normal adult height. Individual rare cases have been reported, however, where ICS use was associated with clinically relevant growth suppression. Inhaled corticosteroids are the most effective therapy available for maintenance treatment of childhood asthma. Fear of reduced growth velocity is based on exceptional cases and not on group data. It should, therefore, not be a reason to withhold or withdraw such highly effective treatment in children with asthma.
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