Inhaled corticosteroids reduce growth. Or do they?

Abstract

The class label warning in the United States for inhaled corticosteroids (ICS's) states that these drugs may reduce growth velocity in children. In this paper, the evidence for this warning is reviewed from a clinical point of view.Children with asthma tend to grow slower than their healthy peers during the prepubertal years because they go into puberty at a later age. However, asthmatic children do achieve a (near) normal adult height. In randomized controlled clinical trials, the use of inhaled beclomethasone, budesonide and fluticasone is associated with a reduced growth during the first months of therapy, in the order of magnitude of approximately 0.5–1.5 cm·yr−1. It is, however, unlikely that such an effect continues or persists because accumulating evidence shows that asthmatic children, even when they have been treated with ICS for years, attain normal adult height. Individual rare cases have been reported, however, where ICS use was associated with clinically relevant growth suppression.Inhaled corticosteroids are the most effective therapy available for maintenance treatment of childhood asthma. Fear of reduced growth velocity is based on exceptional cases and not on group data. It should, therefore, not be a reason to withhold or withdraw such highly effective treatment in children with asthma.

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

“…24,30 The continuous treatment of patients with asthma through inhaled medicine provides safe and effective long-term disease management. 45 Studies have suggested an association of superior COC with fewer ED visits in different populations with asthma. 23,26,30,41,46 Our findings are consistent with those reported in a previous study focusing on children.…”

Long-term asthma treatment guided by airway hyperresponsiveness in children: a randomised controlled trial

“…Previous studies designed to evaluate growth in asthmatic children have shown that growth rates are commonly reduced during the first months of ICS treatment, but that this does not affect adult height [36]; thus, a negative effect on adult height is unlikely. Error bars represent SEM.…”

Pengaruh Kortikosteroid Inhalasi terhadap Pertumbuhan

“…Kortikosteroid inhalasi yang paling sering digunakan adalah beklometason. 6 Sediaan kortikosteroid yang sering kita kenal antara lain tertera pada Tabel 1.…”

“…Faktor ini penting pada anak karena jumlah obat yang ditelan lebih besar daripada yang dihirup (Gambar 1). 5,6 Pada saat obat diabsorbsi akan terjadi efek secara sistemik yang tergantung dari jumlah obat yang diabsorbsi, potensi, dan farmakokinetik obat. 5,7,.8 Sehingga dalam memberikan kortikosteroid inhalasi sebaiknya dalam dosis di bawah dari dosis yang menimbulkan efek sistemik.…”