Influence of inhaled corticosteroids on pubertal growth and final height in asthmatic children

Abstract

Background Controversial data exist on the possibility that inhaled corticosteroids (ICs) affect growth in children with mild‐to‐moderate asthma. We assessed whether ICs affect growth and final height (FH) in asthmatic children compared to controls. Methods A retrospective study was conducted on 113 asthmatic children compared with 66 control children. Asthmatic children presented with mild‐to‐moderate asthma and had exclusive ICs. Anthropometric data of four specific time‐points were collected for both groups (pre‐puberty, onset and late puberty, and FH) and converted to standard deviation scores (SDS). Growth trajectories were assessed as follows: (i) in puberty, using peak height velocity (PHV) and pubertal height gain SDS (PHG‐SDS); (ii) until FH achievement, using FH‐SDS and FH gain SDS (FHG‐SDS). Repeated measurement analysis was performed across longitudinal study visits. A general linear model (GLM) was performed in asthmatic group evaluating the effect of corticosteroid type, treatment duration, and cumulative dose on FH corrected for multiple variables. Results At pre‐puberty, height and weight SDS were similar between the groups (p > 0.05). Height SDS progressively declined over the study period in asthmatic patients from pre‐puberty to FH (p‐trend < 0.05), whereas it did not change over time in controls (p‐trend > 0.05), in both boys and girls. Asthmatic children had exclusive ICs [budesonide (n = 36) vs. fluticasone (n = 43) vs. mometasone (n = 34)] for a mean period of 6.25 ± 1.20 years and a mean cumulative dose of 560.07 ± 76.02 mg. They showed decreased PHG‐SDS and lower PHV compared to controls (all p < 0.05). FH‐SDS and FHG‐SDS were significantly reduced in asthmatic group compared to controls. FH in asthmatic patients was 2.5 ± 2.89 cm lower in boys and 2.0 ± 2.03 cm lower in girls than controls. The GLM showed that FH achievement was dependent on the type of ICs, duration of the treatment, and cumulative dose (p < 0.05). Conclusions ICs affect pubertal growth determining reduced final height in asthmatic children compared to controls, in a dose‐ and duration‐dependent manner.