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Inhaled corticosteroids and growth
1Children's Clinic Randers, Denmark. o.d.wolthers@dadlnet.dk
Insights
Inhaled corticosteroids (ICS) may pose a risk of growth suppression in children with asthma. Careful consideration of drug type, dose, and delivery method is crucial for assessing this risk.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Endocrinology
Background:
- Inhaled corticosteroids (ICS) are a cornerstone therapy for childhood asthma.
- Systemic absorption of ICS raises concerns about potential growth suppression in pediatric patients.
- Previous studies on ICS and growth have methodological limitations.
Purpose of the Study:
- To evaluate the risk of growth suppression in children with asthma treated with inhaled corticosteroids.
- To identify factors influencing the risk of growth suppression, including drug, dose, and delivery system.
- To provide guidance on minimizing potential growth effects of ICS in pediatric asthma management.
Main Methods:
- Review of existing literature on inhaled corticosteroids and pediatric growth.
- Analysis of short-term study data on specific ICS, doses, and delivery devices.
- Consideration of administration regimens and treatment compliance.
Main Results:
- Low-dose budesonide (200-400 mcg/day) and fluticasone propionate (200 mcg/day) via metered-dose inhaler with spacer or dry powder inhaler showed no significant growth effects in mild asthma.
- Higher doses of budesonide (800 mcg via MDI/spacer or 400 mcg via DPI) may be associated with a greater risk of growth suppression.
- Once-daily morning dosing may reduce the risk of growth suppression.
Conclusions:
- The risk of growth suppression from inhaled corticosteroids in children with asthma is dose- and drug-dependent.
- Careful selection of ICS, dose, and delivery method is essential for optimizing asthma control while minimizing growth concerns.
- In severe asthma, the benefits of high-dose ICS outweigh the potential risk of mild growth suppression.
Abstract:
Since inhaled corticosteroids may circulate systemically, a risk of growth suppression in asthmatic children treated with these drugs cannot be ruled out. When assessing the risk, specific drugs, delivery systems, doses, administration regimens, and compliance with treatment regimens must be considered. Although reassuring results have been reported, methodological flaws have meant that the published follow-up evaluations of final height may not be valid for the sound assessment of any growth effects of inhaled corticosteroids. Short-term studies suggest that twice-daily administration of budesonide 200-400 microg delivered from a metered-dose inhaler with a spacer, dry powder budesonide 200 microg, and fluticasone propionate 200 microg per day in children with mild asthma, are not associated with growth-rate effects. The risk may become significant with budesonide 800 microg administered via a metered-dose inhaler with a spacer, and with 400 microg from a dry powder inhaler. The risk of growth suppression can be reduced by dosing once daily in the morning. In children with severe asthma, high doses of inhaled corticosteroids may be potentially lifesaving and thus outweigh the potential risk of mild growth suppression.