The linear relationship between changes in childhood growth velocity and topical glucocorticoid dose

The concept of therapeutic indices for glucocorticoid treatment of rhinitis and asthma requires demonstration of the dose dependency of benefits and side effects. Therefore, we examined the relationship between glucocorticoid dose and changes in growth velocity (delta GV). The literature was reviewed for articles where the net delta GV could be calculated among steroid and parallel placebo, active treatment, or baseline run-in periods. Steroid dose and delta GV were analyzed by linear regression for 5 rhinitis and 19 asthma studies using topical budesonide, beclomethasone, fluticasone and mometasone, parenteral steroids, and nonsteroid comparitors. Dose dependency was established between 0 and the equivalent of 2000 micrograms/day of beclomethasone (r2 = 0.60). delta GV was not significantly affected by 200 micrograms/day of BDP or less. Nasal and bronchial administrations appeared to give equivalent responses. Growth suppression occurred within 2 weeks, and may be linked to a delay in the onset of puberty. The physiology of these effects was discussed.