Effects of inhaled or nasal glucocorticosteroids on adrenal function and growth

Inhaled and nasal glucocorticosteroids (GCS) have being shown to be very effective in the treatment of persistent asthma and allergic rhinitis. However, there has been great concern about the possible effects of these inhaled or nasally administered drugs upon the growth of patients of pediatric age. One of the possible glucocorticoid actions of GCS is reflected by the suppression of adrenal function, suggesting a peripheral direct effect of circulating GCS on the cartilage. The present review addresses the safety of inhaled and nasal GCS by assessing the literature on their effects on adrenal gland function and on growth in children and adolescents. It can be concluded that, at recommended doses, adrenal function is rarely suppressed. High doses of inhaled GCS seem to decrease short-term prepubertal growth, but available studies of final height show that it is not affected at licensed doses. Despite these observations, physicians should monitor the growth of their patients, particularly when a new drug is introduced.