Effect of Inhaled Glucocorticoids in Childhood on Adult Height

Abstract

BACKGROUND The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children. The resulting decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height. METHODS We measured adult height in 943 of 1041 participants (90.6%) in the Childhood Asthma Management Program; adult height was determined at a mean (±SD) age of 24.9±2.7 years. Starting at the age of 5 to 13 years, the participants had been randomly assigned to receive 400 μg of budesonide, 16 mg of nedocromil, or placebo daily for 4 to 6 years. We calculated differences in adult height for each active treatment group, as compared with placebo, using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry. RESULTS Mean adult height was 1.2 cm lower (95% confidence interval [CI], −1.9 to −0.5) in the budesonide group than in the placebo group (P = 0.001) and was 0.2 cm lower (95% CI, −0.9 to 0.5) in the nedocromil group than in the placebo group (P = 0.61). A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height (−0.1 cm for each microgram per kilogram of body weight) (P = 0.007). The reduction in adult height in the budesonide group as compared with the placebo group was similar to that seen after 2 years of treatment (−1.3 cm; 95% CI, −1.7 to −0.9). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in prepubertal participants. CONCLUSIONS The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height, although the decrease was not progressive or cumulative.

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

“…Systemic corticosteroid-related weight gain may further impact negatively on asthma control [193]. In prepubertal children, the initial use of 400 mg of budesonide daily led to a small decrease in initial height (mean: -1.3 cm), that was accompanied by a persistent reduction in adult height, although the decrease was neither progressive nor cumulative [194]. Therefore, use of continuous systemic corticosteroids, and perhaps to a lesser degree high dose ICS, should be accompanied by prudent monitoring of weight, blood pressure, blood glucose, eyes and bone density and, in children, appropriate growth.…”

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

“…Final adult height showed a mean reduction of -1.20 cm with budesonide versus placebo in a high-quality RCT by Kelly et al [109]. A larger daily dose was associated with a lower adult height.…”

Inhaled Corticosteroids in Lung Diseases

“…Elderly patients and patients with severe COPD receiving high-dose ICSs should receive appropriate prophylaxis with vitamin D and calcium. Similar to osteoporosis, the risk of cataracts has been reported to be associated with dose and duration of ICSs in elderly patients; however, a long-term prospective trial of 4 to 6 years plus an additional 8-year follow-up with continuous and intermittent therapy did not find an association between ICSs and cataracts (69).…”