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Glucocorticoids and growth in asthmatic children
1Ira & Jacqueline Neimark Laboratory for Clinical Pharmacology in Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206, USA.
Insights
Asthma and glucocorticoid treatments can affect child growth. While oral steroids may impair growth, inhaled steroids show a small risk, especially at lower doses, necessitating careful monitoring.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Pharmacology
Background:
- Asthma can independently affect pubertal onset and growth in children.
- Glucocorticoid medications are commonly used for asthma management.
- Concerns exist regarding the impact of glucocorticoids on pediatric growth and development.
Purpose of the Study:
- To review the effects of asthma and glucocorticoid therapy on growth in children.
- To evaluate the risks associated with oral versus inhaled glucocorticoid administration.
- To highlight the importance of monitoring growth in children undergoing glucocorticoid treatment.
Main Methods:
- Review of previous reports and studies on asthma, puberty, and growth in children.
- Analysis of data concerning oral and inhaled glucocorticoid effects on growth.
- Consideration of emerging techniques like knemometry for growth assessment.
Main Results:
- Asthma itself may delay puberty, mimicking growth suppression.
- Oral glucocorticoids appear to impair growth, with dose and frequency influencing risk.
- Inhaled glucocorticoids, particularly at lower doses, show a small risk of growth impairment; data on higher doses are limited.
- Knemometry detected short-term growth effects from both oral and inhaled glucocorticoids, though study limitations exist.
Conclusions:
- Clinicians must recognize the potential for glucocorticoid-induced growth impairment in children.
- Awareness allows for adequate monitoring and timely intervention.
- Further research is needed, especially on the effects of higher-dose inhaled glucocorticoids.
Abstract:
The effects of asthma and oral and inhaled glucocorticoid therapy on growth in children are reviewed. Previous reports have shown that asthma itself may delay the onset of puberty, an effect which may masquerade as growth suppression. Oral glucocorticoids appear to impair growth; however, lower doses and alternate-day therapy may have less risk of this effect. While a controversial topic, inhaled glucocorticoids in lower doses appear to be associated with a small risk of adverse effects on growth. Minimal data are available for higher doses. Knemometry, a relatively new technique used for measuring small changes in growth, has detected short-term effects with both oral and inhaled glucocorticoids therapy. However, a number of limitations are associated with short-term growth studies. Clinicians should be aware of the potential for growth impairment with glucocorticoid therapy so adequate monitoring can be undertaken and appropriate intervention introduced when deemed necessary.