Update of growth effects of inhaled and intranasal corticosteroids

A small effect (approximately 1 cm) of inhaled and intranasal corticosteroids on the 1 year growth of children with asthma and allergic rhinitis, respectively, has been reported in studies published during the past 10 years. Literature published during the past year confirmed the effect, but provided additional and novel information on the effects of longer-term (over 1 year) treatment, particularly with inhaled corticosteroids. This information is timely, because the longer-term effect size and duration were previously unknown, and the findings have major implications for the content of the safety discussion between caregivers and the parents of children with asthma or allergic rhinitis. The results of these studies provide very reassuring information about the longer-term safety of the use of inhaled corticosteroids in children with asthma. Limited evidence has also supported the notion that intranasal corticosteroids have no longer-term effects on growth. The possibility of an idiosyncratic (versus global) effect received conflicting support in recent literature. The risk of growth retardation can be lessened and managed by the employment of several simple strategies: (i) monitor growth; (ii) use minimal effective dose; and (iii) optimize steroid-sparing strategies. Communication with patients/parents about this possible side-effect, as well as the adverse consequences of the non-use of inhaled and intranasal corticosteroids, is essential to minimize any possible negative impact on adherence. Children whose disease severity warrants inhaled or intranasal corticosteroid therapy should not be denied their benefits on the basis of this safety consideration.