Official Professional Review and Summary
From “Allergy and Asthma Proceeding” Sept-Oct 2013, Vol 34, No. 5, Page 480
What is the problem and what is known so far?
Inhaled Corticosteroids (ICSs) are an effective therapy for the treatment of patients with persistent asthma of all severities because they reduce underlying inflammation, improve lung function, reduce symptoms, and improve the overall control of asthma. Although ICSs are generally safe for long t erm use, there is concern among physicians and patients about potential side effects, including growth inhibition in children when given over long periods of time. Based on existing evidence, the FDA (Food and Drug Administration) requires labeling on ICSs stating that they may cause a reduction in growth velocity when administered for pediatric patients. Although there are clinical studies that show that ICSs can have minimal effects on growth, the vast majority of these studies have limitations and have not been conducted in a standardized fashion according to current guidance from the FDA. A thorough understanding of these potential adverse effects is essential for proper use of ICSs because public concern of systemic side effects could discourage use of these effective agents for the treatment of asthma.
Why did the Researchers do this particular study?
To analyzed studies performed with currently available ICSs and to determine their level of conformance with the current FDA guidelines.
Who/What was studies?
Review of studies performed with currently available ICSs.
How was the study done?
Study of available ICSs from the standpoint of age, dose, duration fo treatment and 2 measurements of height: 1) standing height(stadiometry) and 2) distance between knee and heel of a sitting child/adolescent (knemometry).
What were the limitations of the study?
The wide variability in the design of the studies with reference to ICSs preparation, dose and degree of asthma and length of treatment.
What are the implications of the study?
The researchers found that studies of children found minimal to no significant effects on growth. When effects were seen they were associated with long term use; however ICS preparations may differ in their effects on growth. Children treated for 1 year with ICSs showed a small, dose-dependent effect of most ICSs on childhood growth. Some ICSs, at the doses studied did not effect growth. Although the data are conflicting, the effect of ICSs on final adult height are dependent on the dose used, and may result in an approximate 1.2cm (less than ½ and inch) reduction in final adult height. Balancing this concern, however, the availability of ICSs for asthma treatment has provided a mainstay of asthma treatment that is far safer than the long term use of systemic corticosteroids.