Health experts who conducted the review and published it in The
Cochrane Library journal found that children's growth slowed in the
first year of treatment, although the effects were minimized by
using lower doses.
Steroid-containing inhalers are prescribed as first-line treatments
for adults and children with persistent asthma.
They are the most effective asthma control drugs and have been shown
to reduce asthma deaths, hospital visits and improve quality of life
by cutting the number and severity of attacks.
Yet their potential effect on children's growth is a source of worry
for parents and doctors - a factor which prompted the Cochrane
reviewers to analyze the evidence more closely.
"The evidence... suggests that children treated daily with inhaled
corticosteroids may grow approximately half a centimeter less during
the first year of treatment," said Linjie Zhang at the Federal
University of Rio Grande in Brazil, who led the review. "But this
effect is less pronounced in subsequent years, is not cumulative,
and seems minor compared to the known benefits of the drugs for
According to data from the World Health Organization (WHO), some 235
million people worldwide suffer from asthma, a chronic disease which
inflames and narrows the air passages of the lungs. The disease is
common among children.
The first of the two systematic reviews focused on 25 trials
involving 8,471 children up to 18 years old with mild to moderate
persistent asthma. These trials tested almost all the available
inhaled corticosteroids and showed they suppressed growth rates when
compared to placebos or non-steroidal drugs.
Fourteen of the trials reported growth over a year and found the
average growth rate, which was around 6 to 9 centimeters (2.4 to 3.5
inches)per year in control groups, was about 0.5 cm (0.2 inch) less
in the groups of children being treated with inhaled steroids for
In the second review, researchers looked at data from 22 trials in
which children were treated with low or medium doses of inhaled
Only three trials followed 728 children for a year or more and the
reviewers said they showed that using lower doses of inhaled
corticosteroids, by about one puff per day, improved growth by
around a quarter of a centimeter (0.1 inch) at one year.
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Francine Ducharme of the University of Montreal in Canada, who
worked on both reviews, said the findings were important and should
prompt more frequent and detailed tracking of childhood asthma
"Only 14 percent of the trials we looked at monitored growth in a
systematic way for over a year," she said. "This is a matter of
major concern given the importance of this topic."
She said her team would recommend the minimal effective dose be used
in children with asthma until further data becomes available.
"Growth should be carefully documented in all children treated with
inhaled corticosteroids, as well in all future trials testing (them)
in children," she said.
Experts not directly involved in the reviews cautioned, however,
that the growth effects were minimal and should not prompt asthma
patients to stop taking their medication.
"These studies confirm what many have suspected, that inhaled
steroids can suppress growth in children," said Jon Ayres, a
professor of environmental and respiratory medicine at Britain's
"However, the effect seems... small and non-cumulative and many may
consider this a risk worth taking compared to the alternative, which
is poorly controlled and therefore potentially life threatening
(Editing by Dan Grebler)
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