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Inhaled corticosteroid therapy for asthma in preschool children: growth issues
1Department of Pediatrics, Division of Endocrinology, University of Wisconsin Children's Hospital, Madison, Wisconsin 53792, USA. dballen@facstaff.wisc.edu
Insights
Inhaled corticosteroids (ICS) may cause short-term growth suppression in children with asthma. However, long-term studies show minimal impact on final adult height, indicating a need for age-specific infant and toddler research.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
- Asthma Management
Background:
- Inhaled corticosteroids (ICS) are the primary preventive treatment for persistent asthma.
- Concerns exist regarding the impact of ICS on growth in infants and young children.
- Glucocorticoids can inhibit growth through various mechanisms, including effects on growth hormone (GH) and insulin-like growth factor-1.
Purpose of the Study:
- To review the existing literature on the benefits and risks of ICS therapy in infants and young children, focusing on growth.
- To evaluate the potential for growth suppression associated with ICS use in pediatric asthma patients.
Main Methods:
- Review of studies assessing ICS therapy in infants and young children.
- Analysis of data on growth suppression, final adult height, and bone mineral density.
- Consideration of different growth phases and susceptibility to glucocorticoid effects.
Main Results:
- Short-term growth suppression has been observed with ICS use at various dosages.
- Long-term studies suggest a negligible effect of ICS on final adult height and bone mineral density.
- Susceptibility to growth suppression may be higher during transitional growth phases, especially prepubertal years.
Conclusions:
- While short-term growth effects are possible, long-term data on ICS use in children is reassuring regarding final height.
- Age-specific studies are necessary to understand ICS effects in infants and very young children, considering differences in drug deposition and growth axis resilience.
Abstract:
Although inhaled corticosteroids (ICS) have emerged as the preventive treatment of choice for persistent asthma, few studies have been conducted in infants and very young children that assess the benefits and risks of ICS therapy, particularly with regard to growth. Oral glucocorticoids inhibit growth at multiple levels by blunting pulsatile growth hormone (GH) secretion, decreasing insulin-like growth factor-1 bioactivity, and directly inhibiting new collagen synthesis. Normal childhood growth can be divided conceptually into 3 phases according to primary growth-supporting factors: nutrition-dependent growth of infancy, GH-dependent childhood growth, and sex steroid/GH stimulation of pubertal growth. Susceptibility to glucocorticoid-induced growth suppression appears to increase during periods of transition from one phase to another, particularly in the immediate prepubertal years. Studies using ICS at varying dosages demonstrate the possibility of short-term growth suppression, but long-term studies suggest a negligible effect, if any, on final adult height or bone mineral density. Although certain speculations regarding the safety of ICS use in infants and very young children can be made based on these data, age-specific studies are needed to account for effects of differences in oral versus airway deposition and growth axis resiliency, which may occur in these patients.
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