Assessing the effect of intranasal steroids on growth

Several studies have evaluated the effects of childhood use of corticosteroids on growth. In short-term studies, the budesonide (BUD) metered dose inhaler and methylprednisolone (injection) had significant effects on lower-leg growth, whereas terfenadine did not. When two doses of BUD (nasal inhaler, 200 or 400 microg once daily) were compared with placebo, only the 400-microg dose had a significant effect on short-term growth. Intranasal mometasone furoate (MF) (100 and 200 microg) had no significant effect on short-term lower-leg growth. In intermediate studies of 1-year duration, intranasal beclomethasone dipropionate (84 microg twice daily) significantly affected growth rate, whereas in a separate study, 100 microg intranasal MF once daily did not. Long-term growth data come from retrospective studies of children with asthma. In these studies, no significant effect on growth has been demonstrated in children taking inhaled beclomethasone dipropionate or BUD. The reason for the discrepancy between intermediate and long-term studies is unclear and warrants further study. Variables in childhood growth including seasonal variations may make growth difficult to assess. However, because growth suppression has been reported in children receiving inhaled or intranasal corticosteroids, the lowest effective dose of drug with a low systemic absorption ratio should always be used. Overall, there appears to be no growth suppression with 100 microg intranasal MF used once daily in children.