Asthma

Inhaled steroids and inhaler types differ in effects on growth: Cochrane review


When it comes to effects on growth in children, there are differences between inhaled corticosteroid molecules used for asthma treatment and also the type of inhaler device, a Cochrane review has found.

Fluticasone seemed to inhibit growth less than beclomethasone and budesonide when given at an equivalent dose, the systematic review of six randomised head-to-head trials of inhaled corticosteroids involving 1199 children with asthma concluded

And in terms of inhaler device, an Easyhaler was marginally but significantly less likely to have adverse effects on growth than Turbuhaler when used for delivery of budesonide, the review authors said.

“However, the evidence from this review is not certain enough to help people select which inhaled corticosteroid or inhalation device to use for the treatment of children with asthma. Further studies are needed,” the review authors concluded.

The review authors, from the Cochrane Airways group, noted that previous reviews had found mean growth reductions in children of ‐1.0 cm/year with beclomethasone, ‐0.61 cm/year with budesonide, ‐0.15 cm/year with ciclesonide, ‐0.42 cm/year with fluticasone, and ‐0.67 cm/year with mometasone. Previous review shad also shown that growth effects of inhaled corticosteroids were dose related, but the findings were not been based on head-to-head comparisons and had not considered the effects of different inhaler types.

Despite the new findings, they emphasised that the potential risk of a relatively small suppression in growth with inhaled corticosteroids in children would be outweighed by their well‐established benefits in controlling asthma.

“Fear of drug side effects means some children do not take their steroid inhalers as prescribed, leading to poor asthma control. Uncontrolled asthma can also impair children’s growth, and can cause significant morbidity and mortality,” they noted.

The implications for practice were that selection of inhaled corticosteroid and delivery device should be based on the efficacy, overall safety profile, ease of use, availability, cost of treatment, and preference of the child, they suggested.

“No matter the type of drug and inhalation device, use of the lowest effective dose of inhaled corticosteroid along with regular monitoring of growth are recommended for all asthmatic children who receive long‐term treatment with inhaled corticosteroid.

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