ESPE Abstracts

Background: Inhaled corticosteroids (ICS) are used frequently in infants with recurrent wheezing. They may have potential adverse effects as treatment of childhood asthma with ICS decreases growth velocity and adult height. ICS treatment in infancy is thought to alter linear growth only little, but however, studies on ICS use in infancy and linear growth are practically lacking.

Objective and hypotheses: To evaluate the impact of ICS on linear growth during infancy.

Method: A population-based cohort of 6391 boys and 6091 girls with data on primary care height and weight measurements, parental heights and drug purchases from birth to 24 months was collected. Height-for-age deviation from the target height (TH) and height velocity (HV) were calculated, and expressed as z-scores (zTH and zHV) at the median age of 24 months (interquartile range 24–26 months). These were compared between ICS (fluticasone and budesonide) exposed and unexposed infants using the analysis of covariance with maternal, perinatal, auxological and medication factors as covariates.

Results: ICS exposed infants were on average shorter than the unexposed infants ((adjusted zTH and zHV differences −0.16 (95% CI −0.22 to −0.11, P<0.001) and −0.28 (−0.37 to −0.19, P<0.001)). The effect was most pronounced after exposure to budesonide prior to 12 months of age (zTH −0.31 (−0.46 to −0.16) and zHV −0.34 (−0.58 to −0.09)) or lasting more than 6 months (zTH −0.63 (−0.89 to −0.37) and zHV −0.70 (−1.13 to −0.27)).

Conclusion: Long-term treatment of ICS during infancy was associated with stunted growth at or after the age of 24 months in otherwise healthy children. Stunting of linear growth in infancy may cause permanent loss of growth potential with decreased adult height. These observations highlight the importance of appropriate use of inhaled corticosteroids in infants.

Funding: This work was supported by the Päivikki and Sakari Sohlberg Foundation and the Kuopio University Hospital State Research Funding.