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Growth and the growth hormone axis in prepubertal children with asthma
S Crowley1, P C Hindmarsh, D R Matthews
1Endocrine Unit, Middlesex Hospital, London, United Kingdom.
Insights
Asthma treatment with inhaled corticosteroids may slow growth in children. However, this study found no significant impact on the growth hormone axis, suggesting growth issues are not due to major hormonal disruptions.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Asthma is a common chronic respiratory disease in children.
- Inhaled corticosteroids (ICS) are a primary treatment for pediatric asthma.
- Concerns exist regarding the potential impact of ICS on childhood growth and the growth hormone (GH) axis.
Purpose of the Study:
- To investigate the effects of asthma and ICS treatment on linear growth, growth velocity, and the GH axis in prepubertal children.
- To differentiate the impact of different ICS medications and delivery devices on growth.
- To assess potential hormonal disturbances related to growth impairment.
Main Methods:
- A 12-month longitudinal study involving 56 prepubertal children with asthma (aged 4.4–11.7 years).
- Regular measurements of height, weight, skin-fold thickness, lung function, and bone age.
- Assessment of 24-hour serum GH profiles and fasting insulin-like growth factor I (IGF-I) levels.
Main Results:
- A significant proportion of children, particularly girls, had heights below the 50th percentile.
- Slow growth was observed in children treated with beclomethasone, budesonide, and combined inhaled steroids with prednisolone.
- No significant alterations in GH secretion or IGF-I levels were detected across treatment groups.
Conclusions:
- Slow linear growth in prepubertal children with asthma treated with ICS is a notable concern.
- The observed slow growth does not appear to be linked to significant dysregulation of the GH axis.
- Further research may be needed to elucidate the mechanisms behind ICS-associated growth deceleration.
Abstract:
To determine the influence of asthma and its treatment with inhaled corticosteroids on growth, linear growth velocity, and the growth hormone axis in prepubertal children, we performed a longitudinal study for 12 months in 56 children with asthma, aged between 4.4 and 11.7 years. Height, weight, skin-fold thickness, and lung function were measured every 3 months and bone age at entry to and exit from the study. A 24-hour serum growth hormone concentration profile and fasting insulin-like growth factor I levels were measured halfway through the year. Seventy-four percent of boys and 62% of girls had heights below the 50th percentile. Growth velocity in the nonsteroid-treated control group (n = 13) was normal; 10 of 20 children taking beclomethasone grew slowly (14/20 used a dry powder device), and 4 of 19 children taking budesonide grew slowly (15/19 used a spacer). Three of four children using inhaled steroids and prednisolone grew slowly. In none of the treatment groups were measures of growth hormone secretion or levels of radioimmunoassayable serum insulin-like growth factor I affected. We conclude that slow growth in steroid-treated children with asthma does not appear to be associated with major perturbations in the growth hormone axis.