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Inhaled corticosteroids in children with persistent asthma: effects on growth
Linjie Zhang1, Sílvio O M Prietsch, Francine M Ducharme
1Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil. zhanglinjie63@yahoo.com.br.
Evidence-Based Child Health : a Cochrane Review Journal
|December 16, 2014
Summary
Inhaled corticosteroids (ICS) for persistent asthma in children may slightly reduce linear growth velocity by approximately 0.5 cm/year during the first year of treatment. This effect appears molecule-dependent and less pronounced in subsequent years.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Growth and Development
Background:
- Inhaled corticosteroids (ICS) are first-line therapy for persistent asthma in children.
- Concerns exist regarding potential systemic adverse effects of ICS, particularly on linear growth.
Purpose of the Study:
- To assess the impact of ICS on linear growth in children with persistent asthma.
- To explore potential effect modifiers like ICS molecule, dose, duration, device, and patient characteristics.
Main Methods:
- Systematic review and meta-analysis of parallel-group randomized controlled trials.
- Included trials compared daily ICS use (≥3 months) versus placebo or non-steroidal drugs in children up to 18 years.
- Data extraction and risk of bias assessment were performed independently by two reviewers.
Main Results:
- 25 trials (8471 children) analyzed; ICS showed a statistically significant reduction in linear growth velocity (-0.48 cm/y) and height change (-0.61 cm/y) during the first year.
- ICS molecule showed a statistically significant difference in growth reduction, more so than dose or device.
- Growth suppression was maximal in the first year, less pronounced in subsequent years; catch-up growth was limited after treatment cessation.
Conclusions:
- Regular ICS use in children with persistent asthma is associated with a small, primarily first-year reduction in linear growth.
- The ICS molecule appears to be a stronger determinant of growth suppression than dose or device.
- Further research is needed to fully characterize molecule-specific effects and long-term growth outcomes.
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