Inhaled corticosteroids for asthma 'affect child growth', study finds

Inhaled corticosteroid drugs for asthma may suppress child growth and should be limited to the lowest effective dose, though benefits of treatment continue to outweigh risks, according to researchers.

Asthma: warning over corticosteroid use (Photo: SPL)
Asthma: warning over corticosteroid use (Photo: SPL)

A review by The Cochrane Library of 25 trials involving 8,471 children found average growth rates were 0.5cm lower among those using the drugs daily than controls or users of non-steroidal medicines in the first year of treatment.

However, the researchers said the effect was 'minor' compared to the known benefits of the drugs, which can reduce the severity of exacerbations, avoid hospital admissions and prevent deaths.

Nevertheless, they called for more research into how different drug doses affect children's growth. They said that until this evidence is presented, the lowest effective dose should be used in children.

The review assessed trials involving beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, and mometasone. These studies compared daily use of the drugs for at least three months with non-steroidal drugs or placebo in children aged up to 18 with mild to moderate persistent asthma.

A second analysis of 22 trials, which tested the same drugs except flunisolide, showed that lower doses improved growth by a quarter of a centimetre after one year.

Researchers said more long-term research into the effects of inhaled corticosteroids on child growth was needed, particularly as only 14% of the trials considered in the meta-analyses monitored growth in a systematic way for over a year.

Study co-author Francine Ducharme from the University of Montreal, Canada, said: 'We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available. Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing inhaled corticosteroids in children.'

NICE had called for more research on the long-term side-effects of asthma treatment, including effects on growth, in its 2007 technology appraisal of inhaled corticosteroids.

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