Children treated daily with inhaled corticosteroids may grow half a centimeter less during the first year of treatment, according to two systematic reviews published in The Cochrane Library. The review authors found childrens growth slowed in the first year of treatment, although the effects were minimized by using lower doses.
The first systematic review focused on 25 trials involving 8,471 children up to 18 years old with mild to moderate persistent asthma. These trials tested all available inhaled corticosteroids except triamcinolone and showed that, as a group, they suppressed growth rates when compared to placebos or non-steroidal drugs. Fourteen of the trials, involving more than 5,700 children, reported growth over a year. The average growth rate, which was around 6-9 cm per year in control groups, was reduced by about 0.5 cm in treatment groups. 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 and ensuring full lung growth, lead author of the review, Linjie Zhang, MD, PhD, who is based at the faculty of medicine at the Federal University of Rio Grande in Rio Grande, Brazil, said.
In the second review, the same authors, working with two others, reviewed data from 22 trials in which children were treated with low or medium doses of inhaled corticosteroids. Triamcinolone and flunisolide were not tested. Only three trials followed 728 children for a year or more. In the three trials, using lower doses of the inhaled corticosteroids, by about one puff per day, improved growth by a quarter of a centimeter at one year.
Some of the variation could be explained by the drugs used, although since this was an indirect comparison the authors say more evidence is needed. Conclusions about the superiority of one drug over another should be confirmed by further trials that directly compare the drugs, Zhang said in the news release.
More long-term trials and trials comparing different doses also are needed, particularly in children with more severe asthma requiring higher doses of inhaled corticosteroids, the researchers concluded. Only 14% of the trials we looked at monitored growth in a systematic way for over a year, said Francine Ducharme, PhD (nursing), one of the authors of both reviews and senior author of the second review, based at the department of pediatrics at the University of Montreal, in the release. This is a matter of major concern given the importance of this topic. We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available.