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Effect of inhaled corticosteroids on long-term growth in pediatric patients with asthma and allergic rhinitis
Rebecca M Hoover1, John Erramouspe, Edward A Bell
1Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Pocatello, ID, USA.
Insights
Inhaled corticosteroids (ICS) may cause a slight delay in growth for children with asthma or allergic rhinitis, but evidence for a significant decrease in final adult height is limited. Proper ICS use is crucial for managing these conditions effectively.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are a cornerstone in managing persistent asthma and allergic rhinitis in children.
- Concerns exist regarding potential systemic effects, including impact on linear growth and final adult height.
- Balancing the benefits of ICS for disease control against potential growth suppression is critical for optimal patient care.
Purpose of the Study:
- To systematically evaluate the impact of orally and nasally inhaled corticosteroids (ICS) on final adult height in pediatric patients.
- To synthesize evidence from clinical trials regarding growth effects in children with mild to moderate persistent asthma and allergic rhinitis.
Main Methods:
- Comprehensive literature search of MEDLINE, Cochrane Library, and International Pharmaceutical Abstracts (1975-2013).
- Inclusion criteria: prospective, double-blind, randomized, placebo-controlled trials of at least 1-year duration.
- Primary outcomes assessed: growth velocity and final adult height in pediatric populations with asthma or allergic rhinitis.
Main Results:
- Analysis of seven trials and one follow-up study on oral ICS revealed conflicting data; four studies indicated a growth delay of ~1 cm in subsets, one reported a 1.2 cm decrease in final height, and three found no effect.
- Four studies on nasal ICS showed growth delay in one subgroup using supratherapeutic doses, suggesting dose-dependency.
- Conflicting evidence on long-term growth reduction highlights the need for careful dosing to minimize systemic effects while ensuring disease control.
Conclusions:
- Current data are insufficient to definitively establish the class effect of ICS on pediatric growth; further research on systemic effects is warranted.
- Potential underuse of ICS due to growth concerns may lead to suboptimal management of asthma and allergic rhinitis, increasing morbidity.
- Emphasizes treating patients with the lowest effective ICS dose to achieve symptom control and minimize adverse systemic effects, including growth impacts.
Objective:
To evaluate the effect of orally and nasally inhaled corticosteroids (ICS) on final adult height in pediatric patients with mild to moderate persistent asthma and allergic rhinitis.
Data Sources:
MEDLINE (1975-April 2013), Cochrane Library (through 2012), and International Pharmaceutical Abstracts (1975-April 2013) were searched for prospective clinical trials assessing the effects of orally or intranasally ICS use on growth in pediatric patients with asthma or allergic rhinitis using the terms inhaled/intranasal corticosteroid, linear growth, height, and asthma or allergic rhinitis.
Study Selection And Data Extraction:
Eligible articles included double-blind, randomized, placebo-controlled studies of at least 1 year with growth velocity or height as the primary outcome.
Data Synthesis:
Seven trials and 1 follow-up study analyzing the effects of orally ICSs were examined. Of these studies, 4 found a delay in growth in at least 1 subset of its participants of approximately 1 cm, 1 study found a decrease in final adult height of 1.2 cm, and 3 studies found no effect. Of the 4 studies examining nasally ICS, 1 found evidence of growth delay in a subgroup using supratherapeutic dosing. There are conflicting data on whether ICS use causes long-term growth reduction in pediatric patients. The concern surrounding their long-term use including a potential delay or decrease in growth may result in underuse and potential mismanagement of persistent asthma and/or allergic rhinitis. Patients should be treated with the lowest effective corticosteroid dose to achieve symptomatic control while minimizing excessive systemic effects. Orally ICS use may cause a delay in growth, but a decrease in final adult height (1.2 cm) has been documented in only one study. This single report should not preclude daily use of inhaled corticosteroids if needed to decrease the morbidity and mortality associated with pediatric reactive airway disease.
Conclusions:
Continued studies on the systemic effects of ICS are required before truly understanding the class's effect on growth in pediatric patients with asthma and allergic rhinitis. What is understood, however, is the detriment and potential danger of mismanaged asthma care.
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