Question 2: What are the effects of inhaled corticosteroids on growth in children?

摘要

This review summarizes the current evidence regarding the effects of inhaled corticosteroids (ICS) on growth in children with asthma. The evidence from randomized trials showed a mean reduction of -0.48 cm/year (95% CI -0.65 to -0.30) in linear growth velocity and of -0.61 cm (95% CI -0.83 to -0.38) in height during a one-year treatment with ICS. Some first-generation drugs had a slightly larger suppressive effect on growth than newer drugs, with a mean reduction in linear growth velocity of -0.91, -0.59, -0.08 and -0.39 cm/year for beclomethasone, budesonide, ciclesonide and fluticasone, respectively. There was evidence of a dose-response relationship, with medium doses (HFA-beclomethasone or equivalent, 100-200 mu g/day) producing a greater reduction than low doses (50-100 mu g/day), in height, but not in linear growth velocity. ICS-induced growth suppression was less pronounced during subsequent years of treatment.