CQ2　Does inhaled corticosteroids affect growth among children with persistent asthma?

Abstract

 Inhaled corticosteroids (ICS) are recommended as a first-line therapy for children with persistent asthma in Japanese and worldwide asthma guidelines. However, there are several studies reporting its effect on growth. We reviewed the evidence of growth suppression by ICS in previously published randomized controlled trials evaluating this effect.

 Twenty five randomized controlled trials comparing daily use of 6 types of ICS versus either placebo or non-steroid drugs were analyzed. Four were conducted among children younger than 5 years of age. Others were among children aging 5 to 18. There was 0.48 cm/year of linear growth suppression among the ICS treated group during the first year of treatment compared to the placebo group. The magnitude of ICS-related growth reduction differed by the type of drug. There was less or no growth suppression from the second year of treatment. However, a follow up assessment of adult height for one trial showed a significant decrease of 1.2 cm in the ICS treated group. Evidence provided by this review suggests the regular use of ICS can cause growth suppression in children with persistent asthma, which underscores the importance of the correct diagnosis and the optimum dose of ICS to maintain effective control of asthma.