The use of inhaled corticosteroids in children is known to cause a temporary reduction in growth velocity in children. Previous studies have found a reduction in growth in children of 1 to 2 cm, but have also shown that children "catch up" later and reach their predicted adult heights. A new study in the New England Journal of Medicine (NEJM Sept 3, 2012) examined the final adult height in 943 of 1041 participants in the Childhood Asthma Management Program. At the age of 5 to 13 years, patients had been randomly assigned to receive 400 mcg budesonide, 16 mg nedocromil, or placebo daily for 4 to 6 years. Adult heights for each treatment group was compared, adjusting for other patient characteristics and height at trial entry. Mean adult height was 1.2 cm lower in the budesonide group, an inhaled corticosteroid, than in the placebo group. The reduction in height was similar to that seen after only 2 years of treatment. The conclusions of the study were that the initial decrease in attained height associated with inhaled corticosteroids in pre-pubertal children persisted as a reduction in adult height, but the decrease was not progressive or cumulative.
Dr. Kenneth Backman of Allergy & Asthma Care comments: "We've long known that inhaled corticosteroids lead to an initial decrease in growth, but prior studies had suggested that catch-up occurs, and no long-term growth suppression is seen. This study finds an average of 1.2 cm of loss in height in patients treated with moderate dose inhaled steroid for 4 to 6 years starting at ages 5 to 13. While this may at first be alarming, 1.2 cm is less than half an inch. We of course would prefer to see no growth suppression, but loss of less than half an inch in final adult height is a small price to pay for controlled asthma, reduced exacerbations, and ability to play sports and function normally. Oral corticosteroids have a more dramatic effect on growth, so the goal is to avoid the need for these whenever possible. At Allergy & Asthma Care, we always strive to use the least medication necessary to control asthma."