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Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth
Aniela I Pruteanu1, Bhupendrasinh F Chauhan, Linjie Zhang
1Research Centre, CHU Sainte-Justine and the Department of Pediatrics, University of Montreal, Montreal, Canada.
Evidence-Based Child Health : a Cochrane Review Journal
|December 16, 2014
Summary
Inhaled corticosteroids (ICS) at higher doses slightly reduced growth velocity in children with asthma. Lower doses are recommended to minimize this effect, though more research is needed.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Trials
Background:
- Inhaled corticosteroids (ICS) are primary treatments for persistent childhood asthma.
- Concerns persist regarding ICS's potential to suppress growth in children.
Purpose of the Study:
- To determine if increasing ICS dosage correlates with reduced linear growth, weight gain, and skeletal maturation in pediatric asthma patients.
- To assess the impact of different ICS doses on growth parameters.
Main Methods:
- Systematic review and meta-analysis of parallel-group randomized trials.
- Searched Cochrane Airways Group Specialised Register and ClinicalTrials.gov.
- Included trials comparing different doses of the same ICS in children (1-17 years) with persistent asthma for at least three months.
Main Results:
- A small but statistically significant reduction in linear growth velocity (0.20 cm/y) was observed with higher ICS doses over 12 months (high-quality evidence).
- No significant differences in growth were found for newer ICS molecules (ciclesonide, fluticasone, mometasone).
- Evidence for effects on weight, BMI, and skeletal maturation was of low quality due to imprecision.
Conclusions:
- Higher ICS doses are associated with a slight, statistically significant decrease in growth velocity in children with mild to moderate persistent asthma.
- The minimal effective ICS dose should be used in children with asthma.
- Systematic documentation of growth in future pediatric ICS trials is crucial.
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