Influence of inhaled corticosteroids on growth: a pediatric endocrinologist's perspective

Abstract

Given the increasing advocacy for the use of inhaled corticosteroids as a treatment of choice for persistent asthma, growing numbers of children are being exposed to the possible growth‐suppressing effects of glucocorticoids. Recent evidence strongly suggests that, when consistently administered at moderate doses, inhaled corticosteroids (IC) are capable of slowing growth in children. Whether such growth suppression would persist and ultimately affect final adult height remains unknown. Therapeutic goals which aim for uninterrupted inflammatory disease control rather than periodic symptom control may increase the occurrence of growth failure in children treated with IC. In this article, current information about the mechanisms of growth suppression by glucocorticoids and the effects of IC on growth is reviewed, and recommendations for designing studies to investigate the effects of drugs on growth are presented.

Mechanisms of growth impairment in pediatric Crohn's disease

“…Growth, particu larly in prepubertal children, can be impaired by rela tively modest daily doses of prednisone (3-5 mg/m 2 ). 83 this effect may be reduced, but is not necessarily eliminated, by administration of this therapy on alter nate days. selective elimination of evening doses may avoid blunting of both nocturnal GH secretion and/or adreno corticotropic hormoneinduced adrenal androgen production.…”

“…selective elimination of evening doses may avoid blunting of both nocturnal GH secretion and/or adreno corticotropic hormoneinduced adrenal androgen production. 83 Catchup growth after cessation of gluco corticoid therapy does not always fully compensate for growth deficits, particularly when treatment occurs during puberty. although chronic daily dosing and frequent induction courses of steroids can lead to bone demineralization, at present no good evidence exists that occasional, shortterm use of steroids for the induc tion of remission in Crohn's disease is detrimental to longterm growth.…”

“…the growthsuppressive effects of glucocorticoids are multifactorial and can occur at virtually any point along the growth axis. 83 in general, exogenous corticosteroids are considered to create a state reviews of functional GH deficiency. 84 the dose, preparation and administration schedule of gluco corticoids all influ ence the degree of growth suppression observed.…”

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

“…reduced growth velocity from ICS). [35][36][37] To address these critical questions in childhood asthma, the first trial conducted by the CARE network was Prevention of Early Asthma in Kids (PEAK) study. 38 The main research question posed by PEAK was as follows: can early recognition and treatment of children at increased risk of developing asthma prevent its clinical expression or any alterations in lung function measures that occur as a result of it?…”

Inhaled Corticosteroids and Growth: Still an Issue after All These Years

“…10 Mechanisms by which glucocorticoids inhibit growth include blunting of pulsatile growth hormone release through augmentation of hypothalamic somatostatin tone, down-regulation of hepatic and growth plate growth hormone receptor expression, inhibition of insulin-like growth factor 1 bioactivity and osteoblast activity, acceleration of chondrocyte apoptosis, and suppression of collagen synthesis and adrenal androgen production. Furthermore, ICS compounds are extraordinarily potent glucocorticoids, considered to have 8-23 times the potency of dexamethasone, according to glucocorticoid receptor binding affinity.…”