Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-Analysis

Abstract

BackgroundLong-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth.MethodsWe initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic.ResultsWe found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65).ConclusionUse of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.

Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children

“…This study showed that inhaled corticosteroid therapy affects pubertal growth determining reduced final height in children with asthma and that the growth‐suppression effect is dependent on IC molecule, dose, and duration of the treatment.Our findings on asthma and IC use on height are consistent with other studies reporting that long‐term use of ICs for more than 12 months in asthmatic children is associated with reduction in growth velocity and final height .…”

Decreased frequency of adenoidectomy by a 12-week nasal budesonide treatment

“…Some other studies have demonstrated the therapeutic safety of budesonide inhalation suspension 10–13,22,28. A pilot study showed that treatment with short-term high-dose budesonide (1 mg of budesonide, transnasal nebulization twice daily for 14 days) neither suppressed the hypothalamic–pituitary–adrenal axis nor caused any serious side effects in patients with nasal polyps 10.…”

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

“…A recent meta-analysis of 16 RCT showed that ICS use for [12 months in children significantly reduced growth velocity at 1-year follow-up [108]. 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].…”