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Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children
Chiara De Leonibus1, Marina Attanasi1, Zane Roze2
1Department of Pediatrics, University of Chieti, Chieti, Italy.
Insights
Inhaled corticosteroids (ICs) used for asthma in children can impact growth, leading to reduced final height. This effect is dose- and duration-dependent, with significant differences observed compared to non-asthmatic children.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Controversial data exist regarding inhaled corticosteroids (ICs) and their effect on growth in children with mild-to-moderate asthma.
- This study aimed to clarify the impact of ICs on growth and final height (FH) in asthmatic children.
Purpose of the Study:
- To assess the effect of inhaled corticosteroids (ICs) on growth trajectory and final height (FH) in children with mild-to-moderate asthma.
- To compare growth parameters between asthmatic children using ICs and a control group.
Main Methods:
- Retrospective study comparing 113 asthmatic children (exclusive ICs) with 66 controls.
- Anthropometric data collected at four time-points (pre-puberty, onset puberty, late puberty, FH) and converted to standard deviation scores (SDS).
- Growth trajectories assessed using peak height velocity (PHV), pubertal height gain SDS (PHG-SDS), FH-SDS, and FH gain SDS (FHG-SDS); General Linear Model (GLM) used to evaluate dose- and duration-dependency.
Main Results:
- Asthmatic children showed a progressive decline in height SDS from pre-puberty to FH, unlike controls.
- Asthmatic children exhibited decreased PHG-SDS and lower PHV compared to controls (p < 0.05).
- Final height was significantly reduced in asthmatic children (boys: 2.5 cm lower; girls: 2.0 cm lower) compared to controls, influenced by IC type, duration, and cumulative dose.
Conclusions:
- Inhaled corticosteroids (ICs) negatively impact pubertal growth in asthmatic children.
- Reduced final height in asthmatic children is dose- and duration-dependent.
- ICs necessitate careful monitoring of growth in pediatric asthma patients.
Background:
Controversial data exist on the possibility that inhaled corticosteroids (ICs) affect growth in children with mild-to-moderate asthma. We assessed whether ICs affect growth and final height (FH) in asthmatic children compared to controls.
Methods:
A retrospective study was conducted on 113 asthmatic children compared with 66 control children. Asthmatic children presented with mild-to-moderate asthma and had exclusive ICs. Anthropometric data of four specific time-points were collected for both groups (pre-puberty, onset and late puberty, and FH) and converted to standard deviation scores (SDS). Growth trajectories were assessed as follows: (i) in puberty, using peak height velocity (PHV) and pubertal height gain SDS (PHG-SDS); (ii) until FH achievement, using FH-SDS and FH gain SDS (FHG-SDS). Repeated measurement analysis was performed across longitudinal study visits. A general linear model (GLM) was performed in asthmatic group evaluating the effect of corticosteroid type, treatment duration, and cumulative dose on FH corrected for multiple variables.
Results:
At pre-puberty, height and weight SDS were similar between the groups (p > 0.05). Height SDS progressively declined over the study period in asthmatic patients from pre-puberty to FH (p-trend < 0.05), whereas it did not change over time in controls (p-trend > 0.05), in both boys and girls. Asthmatic children had exclusive ICs [budesonide (n = 36) vs. fluticasone (n = 43) vs. mometasone (n = 34)] for a mean period of 6.25 ± 1.20 years and a mean cumulative dose of 560.07 ± 76.02 mg. They showed decreased PHG-SDS and lower PHV compared to controls (all p < 0.05). FH-SDS and FHG-SDS were significantly reduced in asthmatic group compared to controls. FH in asthmatic patients was 2.5 ± 2.89 cm lower in boys and 2.0 ± 2.03 cm lower in girls than controls. The GLM showed that FH achievement was dependent on the type of ICs, duration of the treatment, and cumulative dose (p < 0.05).
Conclusions:
ICs affect pubertal growth determining reduced final height in asthmatic children compared to controls, in a dose- and duration-dependent manner.
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