Inhaled glucocorticoids (ICS) have been shown to have a temporary decrease in linear growth velocity in children. The effect of ICS on adult height has not been well defined.
Participants (943 of 1041) in the Childhood Asthma Management Program study were enrolled between December 1993 and September 1995. They were between 5 and 13 years of age at that time with mild to moderate asthma. They were randomized to 1 of 3 study groups: either budesonide 400 µg per day via dry-powder inhaler, nedocromil 16 mg per day via pressurized metered dose inhaler, or placebo. The length of the study was 4 to 6 years.
The calculated differences in adult height for each active treatment group as compared with placebo was done using multiple linear regression with adjustment for demographic characteristics, asthma features, and height at trial entry.
Mean adult height was 1.2 cm lower (95% confidence level –1.9 to –0.5) in the budesonide group than in the placebo group (P = .001) and 0.2 cm lower (95% confidence level 0.9 to 0.5) in the nedocromil group than in the placebo group (P = .61). During the first 2 years, decreased growth velocity in the budesonide group occurred primarily in prepubertal girls.
The initial decrease in attained height associated with the use of ICS in prepubertal children persisted as a reduction in adult height, but the decrease was not progressive or cumulative.
This observation in 91% of the best characterized group of mild to moderate asthmatic individuals gives information that the effect on growth velocity seen in the first 1 to 2 years of treatment is not cumulative. These data cannot be extended to other ICS products with different delivery systems.
- Copyright © 2013 by the American Academy of Pediatrics