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Asthma, glucocorticoids and growth
1Department of Allergic Diseases, Helsinki University Central Hospital, Finland.
Insights
Most children with asthma grow normally, but treatments like glucocorticoids (GCs) can impact growth and puberty. Early, inhaled therapies and careful monitoring minimize these effects, ensuring healthier development.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Asthma in children can impact normal growth and pubertal development.
- Glucocorticoids (GCs), a common asthma treatment, carry risks of systemic side-effects, including growth impairment.
- Advances in asthma management, such as early anti-inflammatory therapy and inhaled GCs, are mitigating these risks.
Purpose of the Study:
- To evaluate the impact of asthma and its treatments on childhood growth.
- To assess the evolving effects of modern asthma therapies on growth and puberty.
- To provide guidance on monitoring growth in children receiving GCs.
Main Methods:
- Review of current literature on asthma, growth, and GC treatment in pediatric populations.
- Analysis of the effects of inhaled versus oral GCs on systemic side-effects.
- Discussion of individualized sensitivity to GCs and growth monitoring strategies.
Main Results:
- Asthma and GC treatments can delay puberty and affect growth, though less so with modern therapies.
- Inhaled GCs generally have fewer systemic side-effects than oral GCs.
- Individual responses to GCs vary, necessitating personalized monitoring.
Conclusions:
- Modern asthma management is reducing the negative impact on childhood growth.
- Growth monitoring is crucial for all children treated with GCs, especially at high doses.
- Utilizing the lowest effective GC dose and preparations with minimal systemic bioavailability is recommended.
Abstract:
Most asthmatic children grow normally. However, the disease itself and the treatments used, e.g. glucocorticoids (GCs) may affect growth, especially delaying puberty. Presently, the extensive use of early anti-inflammatory therapy is changing asthma to a milder disease and the effects on growth will probably further decline. Also, the use of inhaled instead of oral GCs has minimized the risk of systemic side-effects. High doses of inhaled GCs have systemic effects, and because there are individual differences in sensitivity to GCs, growth should be monitored in every child treated with GCs. The preparations with the lowest systemic bioavailability and the lowest dose to control asthma should be used.