Linjie Zhang1, Laura Belizario Lasmar2, Jose A Castro-Rodriguez3. 1. Universidade Federal do Rio Grande, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde e Programa de Pós-Graduação em Saúde Pública, Rio Grande, RS, Brazil. Electronic address: lzhang@furg.br. 2. Universidade Federal de Minas Gerais, Faculdade de Medicina, Divisão de Pediatria, Unidade de Pneumologia Pediátrica, Belo Horizonte, MG, Brazil. 3. Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Pediatría, Unidad de Neumología Pediátrica, Santiago, Chile.
Abstract
OBJECTIVES: To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth. DATA SOURCES: The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta-analysis were selected. If there was no such article, the authors selected either randomized clinical trials or observational studies. DATA SYNTHESIS: A total of 37 articles were included in this review. The findings from 21 studies suggest that asthma per se, especially more severe and/or uncontrolled cases, can transitorily impair child's growth. Two Cochrane reviews of randomized clinical trials showed a small mean reduction in linear growth (-0.91cm/year for beclomethasone, -0.59cm/year for budesonide, and -0.39cm/year for fluticasone) in the first year of treatment with inhaled corticosteroids in prepubertal children with persistent asthma. The effects were likely to be molecule- and dose-dependent. A recent review showed that most of "real-life" observational studies had not found significant effects of inhaled corticosteroids on growth in asthmatic children. Fifteen studies showed that the maintenance systemic corticosteroids could cause a dose-dependent growth suppression in children with severe asthma, but other controllers (cromones, montelukast, salmeterol, and theophylline) had no significant adverse effects no growth. CONCLUSIONS: Severe and/or uncontrolled asthma can transitorily impair child's growth. Regular use of inhaled corticosteroids may cause a small reduction in linear growth in children with asthma, but the well-established benefits of inhaled corticosteroids in controlling asthma outweigh the potential adverse effects on growth. Use of the minimally effective dose of inhaled corticosteroids and regular monitoring of child's height during inhaled corticosteroids therapy are recommended.
OBJECTIVES: To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth. DATA SOURCES: The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta-analysis were selected. If there was no such article, the authors selected either randomized clinical trials or observational studies. DATA SYNTHESIS: A total of 37 articles were included in this review. The findings from 21 studies suggest that asthma per se, especially more severe and/or uncontrolled cases, can transitorily impair child's growth. Two Cochrane reviews of randomized clinical trials showed a small mean reduction in linear growth (-0.91cm/year for beclomethasone, -0.59cm/year for budesonide, and -0.39cm/year for fluticasone) in the first year of treatment with inhaled corticosteroids in prepubertal children with persistent asthma. The effects were likely to be molecule- and dose-dependent. A recent review showed that most of "real-life" observational studies had not found significant effects of inhaled corticosteroids on growth in asthmatic children. Fifteen studies showed that the maintenance systemic corticosteroids could cause a dose-dependent growth suppression in children with severe asthma, but other controllers (cromones, montelukast, salmeterol, and theophylline) had no significant adverse effects no growth. CONCLUSIONS: Severe and/or uncontrolled asthma can transitorily impair child's growth. Regular use of inhaled corticosteroids may cause a small reduction in linear growth in children with asthma, but the well-established benefits of inhaled corticosteroids in controlling asthma outweigh the potential adverse effects on growth. Use of the minimally effective dose of inhaled corticosteroids and regular monitoring of child's height during inhaled corticosteroids therapy are recommended.
Authors: Adriana César da Silveira; Álvaro Jorge Madeiro Leite; Poliana Coelho Cabral; Ariclécio Cunha de Oliveira; Keciany Alves de Oliveira; Pedro Israel Cabral de Lira Journal: BMC Pediatr Date: 2021-03-06 Impact factor: 2.125