Pearls of Wisdom: Can Inhaled Corticosteroids Stunt Growth?

Mark is a 13-year-old boy with persistent asthma, which has been well controlled through daily use of inhaled corticosteroids (ICS) for several years. At his latest check-up, Mark's mother notes that Mark is a bit shorter than other boys his age, and asks if his ICS could be causing any growth delay.

Can the use of inhaled corticosteroids stunt growth?

A. Yes, but the growth spurt that occurs after stopping ICS compensates for the delay.
B. Yes, but the amount of adult height lost is so small it is not worth considering.
C. Yes, and the amount of growth retardation may be important to some patients.
D. No

What is the correct answer?
(Answer and discussion on next page)

Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. These “Pearls of Wisdom” often highlight studies that may not have gotten traction within the clinical community and/or may have been overlooked since their time of publishing, but warrant a second look.

Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.

Answer: Yes, and the amount of growth retardation may be important to some patients.

If inhaled corticosteroids (ICS) are generally stronger than leukotriene receptor antagonists (LKTR), why should we consider LKTR?

The Background

From the 1960s through the 1980s, parents began expressing concern that frequent use of ICS in their children could lead to stunted growth. Physicians reassured parents that while ICS for persistent asthma does cause temporary reduction in growth, the children would catch up once ICS use was discontinued. Plus, untreated asthma is also associated with growth delay—so the risk is present either way.

The Research

A 2012 study followed 943 children (age 5-13) who were enrolled in a childhood asthma management program. The treatment was randomized between ICS, an anti-inflammatory, and placebo. The primary outcome measure was adult height at age 25.

ICS and Adult Height Results

The Results

After an average follow-up of 16 years, treatment with ICS was associated with an average height difference of 1.3 cm, compared with placebo.

What’s the “Take-Home”?

Despite the original assumption that the growth delay associated with ICS was only temporary, the results of this study show that it is not. For concerned patients or their parents, we must acknowledge this potential growth impact and respect the importance of a reduction in ultimate attained height if it is important to the patient

Note: While half an inch may not seem like a drastic loss to a treating practitioner, it is ultimately an individual decision whether that 1.3 cm difference is important (also recalling that the upper limit of growth retardation was 1.7 cm)

Reference:

Kelly HW, Sternberg AL, Lescher R, et al. Effect of inhaled glucocorticiods in childhood on adult height. N Eng J Med. 2012;367(10):904-912.