Background: Controversial data exist on the possibility that inhaled glucocorticoids (IGs) affect growth in children with mild-to-moderate asthma. The majority of these studies are short-term reports lacking long-term assessment until the achievement of final height (FH).
Objectives: To assess whether IGs affect growth and FH in asthmatic children compared to controls.
Methods: 113 asthmatic (57/56 (males/females)) were compared to 66 control children (29/37 (males/females)). Asthmatic children presented mild-to-moderate asthma and had exclusive IGs (budesonide (n=36) vs fluticasone (n=43) vs mometasone (n=34)) for a mean-period of 6.56±1.20 years and a mean-cumulative dose of 560.07±76.02 mg. Height and weight were retrospectively collected at four study-visits (pre-puberty, onset and late puberty, FH) and converted to S.D. scores (SDS). Growth trajectories were assessed: 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 glucocorticoid type, treatment duration and cumulative dose on FH-SDS corrected for age, gender, weight-SDS and asthma severity.
Results: At pre-puberty age, 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=0.002), whereas it did not change over time in controls (P-trend>0.05). Asthmatic children showed decreased PHG-SDS compared to controls (−0.30±0.93 vs 0.02±0.46, P=0.016) and lower PHV (5.77±3.13 vs 7.49±2.04, P=0.001). FH-SDS was significantly reduced in asthmatic group compared to controls (−0.24±0.39 vs 0.20±0.60, P=0.004), as well as FHG-SDS (−0.56±0.76 vs 0.04±0.42, P<0.001). The GLM showed a significant effect of glucocorticoid type, duration and cumulative dose on FH-SDS (P<0.05).
Conclusions: IGs affect pubertal growth determining reduced FH in children with asthma compared to controls, in a dose and duration-dependent manner.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology