This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

Asthma medications 'may suppress children's growth'

The height of children who take inhaled corticosteroid (ICS) drugs is reduced by an average of half a centimetre in the first year of taking the drug, concludes a gold-standard evidence review.

Two reviews published by the Cochrane Library today looked at the available evidence and concluded that only the ‘minimal effective dose’ of ICS is used in children with asthma until further data becomes available.

The first review looked at 25 trials involving 8,471 children with mild to moderate persistent asthma. The trials tested six of the seven ICS drugs available worldwide, excluding triamcinolone.

Researchers found that while the average growth rate in control groups was around 6cm to 9cm, children who took daily ICS drugs grew 0.5cm less than their peers on placebo or non-steroidal drugs.

The reviews’ lead author, Dr Linjie Zhang, associate professor at the Federal University of Rio Grande in Brazil, said that the effects on growth were ‘minor’ compared to the known benefits of the drugs for controlling asthma.

Dr Zhang also noted that the effect on growth suppression did not appear to be cumulative, and is less pronounced in subsequent years of taking ICS drugs.

A second systemic review, also published today, looked at data from 22 trials on the effects of ICS dosage on growth. Researchers found that children with mild to moderate asthma who took a low to medium dose of inhaled steroids (about one puff less per day) grew on average a quarter of a centimetre more than those on higher dosages.  

The authors of the reviews are now calling for further trials that directly compare different ICS drugs and dosages. Professor Francine Ducharme, professor of paediatrics at the University of Montreal, who co-authored both reviews, said that it was a ‘matter of major concern’.

She said: ‘Only 14% of the trials we looked at monitored growth in a systematic way for over a year. We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available.’

Readers' comments (3)

  • Am I getting old but what is new about this reseach? Iremember getting taught this in the 1980's? 0.25 cm is a 'major concern'! What do they class repeated infections, exacerbations and admissions as? Because that is what will happen once the Press twist this bit of research.
    ..........Just in case, anyone want to do some research, what is that hot thing that seems to go down in the west at night?

    Unsuitable or offensive? Report this comment

  • Prepare for a summer of nocturnal asthma attacks - headline in Daily Mail - Asthma Inhalers stunt growth. To be fair, they do go into detail about how this is a small price to pay, but the stunting message will no doubt be the one heard. I seem to remember being taught this at medical school over 30 years ago!

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    This is always a difficult area and it poses problem if a child's asthma is severe enough warranting higher doses of inhaled steroids .All these combined preparation like Symbicort, Fostair, Seretide etc are not licensed for <12 years old primarily because of this stunted growth .
    I must say I have a lower threshold to use leukotriene receptor antagonist like Montelukast otherwise.
    Again letting your patient/parents to understand the concept of benefit against risk especially in brittle case, is vital. Steroid phobia should not prevent life saving in asthma .

    Unsuitable or offensive? Report this comment

Have your say