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Growth effects of asthma and asthma therapy
1Pediatrics and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-2583, USA. skonerd@chplink.chp.edu
Insights
Inhaled corticosteroids (ICS) may cause mild, short-term growth suppression in children with asthma. However, benefits outweigh risks, and strategies can manage potential growth effects.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Growth Monitoring
Background:
- Studies from the 1990s indicated a small growth effect from inhaled corticosteroids (ICS) in children with asthma.
- Recent literature confirms mild, one-year growth suppression but also provides data on longer-term treatment effects.
Purpose of the Study:
- To review recent literature on the effects of inhaled corticosteroids on childhood asthma patient growth.
- To inform asthma caregivers, parents, and children about potential growth effects and management strategies.
Main Methods:
- Systematic review of recent studies on inhaled corticosteroid use in pediatric asthma.
- Analysis of growth data and identification of risk mitigation strategies.
Main Results:
- Inhaled corticosteroids show a mild growth suppression effect at one year, with longer-term data now available.
- The growth effect is generally small and can be managed, with conflicting evidence on its idiosyncratic nature.
Conclusions:
- Inhaled corticosteroids remain crucial for asthma management, with benefits generally outweighing minor growth concerns.
- Growth can be monitored, minimal effective doses used, and steroid-sparing strategies employed to mitigate risks.
- Open communication about potential growth effects is essential for adherence and managing patient/parental concerns.
Abstract:
A small effect (1 cm) of inhaled corticosteroids (ICS) on the 1-year growth of asthmatic children was observed in studies published during the 1990s. A high volume of literature published during the past year confirmed mild growth suppression at one year, but provided information on the effects of longer-term treatment. These developments are important, since the effect was previously unknown and the findings have major implications for asthma caregivers and the communication that they have with asthmatic children and their parents. The possibility that this is an idiosyncratic effect received conflicting support. These studies collectively provide support for ICS use and ease the minds of caregivers, parents, and children. The risk of growth retardation can be lessened and managed by the employment of several simple strategies: (1) monitor growth; (2) use the minimal effective dose; (3) optimize steroid-sparing strategies (smoke and allergen environmental controls, vaccinate for influenza, diagnose and treat rhinitis, sinusitis, and gastroesophageal reflux disease, use add-on therapy with a second controller rather than doubling the ICS dose if control is inadequate); and (4) use spacing devices (for pressurized metered-dose inhalers) and mouth rinsing. Open and accurate communication with patients and parents about this possible effect is essential to minimize nonadherence. Ultimately, no child whose disease severity warrants ICS therapy should be denied the tremendous benefits that this therapy can provide because of relatively minor concerns about growth effects.