Evidence-Based Answer
Inhaled corticosteroids have been shown to decrease growth velocity in asthmatic children during the first year of use. However, long-term use of inhaled corticosteroids in children has not been shown to cause a statistically significant decline in the attainment of target adult height. (SOR B, based on cohort studies.)
Little high-grade evidence is available to determine if inhaled corticosteroids affect growth in
asthmatic children. A cohort study evaluated height in a group of Danish asthmatic children
over a 10-year period.1 The authors initially enrolled 332 children who were not currently taking
an inhaled corticosteroid, 270 of whom were assigned to the inhaled corticosteroid budesonide;
the other 62 children did not use the treatment and comprised the control group. Due to a high
dropout rate, only 18 children remained in the control group and 142 in the treatment group by the
end of the study.
By considering such variables as daily and cumulative doses of budesonide, and treatment duration, the authors found no significant correlation between the duration of treatment (P=.16) or the cumulative dose of budesonide (P=.14) and the difference between the measured and target adult heights. The many limitations of this study, including lack of randomization, small sample size, high dropout rate, lack of information on budesonide dose, and lack of intention-to-treat analysis, make it difficult to make firm conclusions about the effect of inhaled corticosteroids on height in asthmatic children.
In 2003, a consortium of the American College of Chest Physicians, the American Academy of Allergy, Asthma, and Immunology, and the American College of Allergy, Asthma, and Immunology conducted a systematic review of evidence on potential complications of inhaled corticosteroid use in asthma.2 They assessed the relationship between inhaled corticosteroid therapy for asthma and bone mineral density, cataracts, glaucoma, growth retardation, and skin thinning.
They found that the benefits associated with inhaled corticosteroid therapy exceed the risks of growth retardation, and concluded that inhaled corticosteroid therapy “is associated with a decrease in short-term growth rates in children, but the overall effect is small and may not be sustained with long-term therapy.” They further stated that “the adult height attained by asthmatic children treated with inhaled corticosteroids is not different from that of nonasthmatic children.”
Robert Kavitt, BS,
University of Chicago Pritzker School of Medicine
Jon O. Neher, MD,
University of Washington
1. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide
on adult height in children with asthma. N Engl J Med 2000; 343:1064–1069.
2. Leone FT, Fish JE, Szefler SJ, West SL, for the Expert Panel on Corticosteroid
Use. Systematic review of the evidence regarding potential complications of
inhaled corticosteroid use in asthma: collaboration of American College of
Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and
American College of Allergy, Asthma, and Immunology. Chest 2003;
124:2329–2340.