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Published on: April 6, 2017
[Inhaled corticosteroids and growth: should we be worried?]
G Pouessel1, I Gueorguieva2, Y Bernaczyk3
1Service de pédiatrie, centre hospitalier de Roubaix, pavillon de pédiatrie médico-chirurgicale, 11-17, boulevard Lacordaire, BP 359, 59056 Lille, France; Unité de pneumologie et allergologie, clinique de pédiatrie, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Insights
Inhaled corticosteroids (ICSs) for asthma may cause a small, early growth reduction in children, but final adult height is minimally affected. The benefits of ICS treatment outweigh potential growth impacts.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Growth and Development
Context:
- Inhaled corticosteroids (ICSs) are a primary treatment for asthma.
- Concerns exist regarding ICSs' potential impact on childhood growth.
- Previous studies on short-term growth effects lack long-term clinical relevance.
Purpose:
- To synthesize available data on the effects of inhaled corticosteroids (ICSs) on growth in children.
- To evaluate the medium- and long-term consequences of ICS therapy on pediatric growth velocity and final adult height.
Summary:
- Medium-term ICS use (≥6 months) shows a slight growth reduction, particularly in younger children, with initial velocity slowing but no catch-up growth.
- Long-term ICS treatment appears to cause a small reduction in final adult height (approx. 1cm), primarily within the first two years, without further progression.
- Further research is needed on factors like gender, age of onset, ICS type, and asthma severity.
Impact:
- The therapeutic benefits of ICSs for asthma management are generally considered greater than the risks associated with growth side effects.
- Optimal asthma control with regular ICS dose adjustment can minimize potential impacts on growth.
- Findings support the continued use of ICSs as a cornerstone therapy for asthma in children.
Abstract:
Inhaled corticosteroids (ICSs) are the cornerstone and the first stage of asthma treatment. The objective of this study was to synthesize data on the potential effects of ICSs on growth in children. Studies on the short-term impact of ICSs on growth evaluated by knemometry cannot be extrapolated to the medium or long term and therefore have no utility in real life for a given person. In the medium term, the various ICSs given at the usual doses cause a small reduction in growth after 6 months of treatment. This slowdown occurs at the beginning of treatment, especially in younger children, and the growth velocity corrects itself later but without catching up. In the long term, the prolonged use of ICSs seems to induce a small reduction in the final size in adulthood (close to 1cm) occurring in the first 2 years of treatment without worsening over time. The impact of gender, age at onset of treatment, different ICSs, modes of inhalation, and severity of asthma should also be studied further. The benefit of ICSs in asthma treatment is greater than the risk of side effects, including on growth. The majority of the therapeutic effect is obtained for small to moderate doses of ICSs. Regular adjustment of ICS dose for optimal asthma control should also reduce ICS dose and the impact on growth.
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