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Scientific review finds asthma inhaled corticosteroids may suppress child growth (2014/09/29)

Corticosteroid drugs given via inhalers to children with asthma may suppress their growth, according to two systematic reviews of scientific studies on the issue.

Treatment guidelines for asthma recommend inhaled corticosteroids (ICS) as first-line therapy for children with persistent asthma. Although ICS treatment is generally considered safe in children, the potential systemic adverse effects related to regular use of these drugs have been and continue to be a matter of concern, especially the effects on linear growth.

 


Health experts who conducted the review and published it in The Cochrane Library journal found that children's growth slowed in the first year of treatment, although the effects were minimized by using lower doses.

The evidence suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment, but this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma.

The effect size of ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose (low to medium dose range).

Compared with placebo or non-steroidal drugs, ICS produced a statistically significant reduction in linear growth velocity (14 trials with 5717 participants, MD -0.48 cm/y, 95% CI -0.65 to -0.30, moderate quality evidence) and in the change from baseline in height (15 trials with 3275 participants; MD -0.61 cm/y, 95% CI -0.83 to -0.38, moderate quality evidence) during a one-year treatment period.

The first of the two systematic reviews focused on 25 trials involving 8,471 children up to 18 years old with mild to moderate persistent asthma. These trials tested almost all the available inhaled corticosteroids and showed they suppressed growth rates when compared to placebos or non-steroidal drugs.

Fourteen of the trials reported growth over a year and found the average growth rate, which was around 6 to 9 centimeters (2.4 to 3.5 inches)per year in control groups, was about 0.5 cm (0.2 inch) less in the groups of children being treated with inhaled steroids for asthma.

In the second review, researchers looked at data from 22 trials in which children were treated with low or medium doses of inhaled corticosteroids.

Only three trials followed 728 children for a year or more and the reviewers said they showed that using lower doses of inhaled corticosteroids, by about one puff per day, improved growth by around a quarter of a centimeter (0.1 inch) at one year.

"Only 14 percent of the trials we looked at monitored growth in a systematic way for over a year," she said. "This is a matter of major concern given the importance of this topic."

Researchers would recommend the minimal effective dose be used in children with asthma until further data becomes available. "Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing (them) in children," she said.

However, additional studies are needed to better characterise the molecule dependency of growth suppression, particularly with newer molecules (mometasone, ciclesonide), to specify the respective role of molecule, daily dose, inhalation device and patient age on the effect size of ICS, and to define the growth suppression effect of ICS treatment over a period of several years in children with persistent asthma.

For more information
Zhang L, Prietsch SOM, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database of Systematic Reviews. Published online July 17 2014.

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