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Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-Analysis.

Loke YK, Blanco P, Thavarajah M, Wilson AM - PLoS ONE (2015)

Bottom Line: Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)).There was evidence of a dose-response effect in three RCTs.In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.

View Article: PubMed Central - PubMed

Affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.

ABSTRACT

Background: Long-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth.

Methods: We initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic.

Results: We found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65).

Conclusion: Use of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.

No MeSH data available.


Related in: MedlinePlus

Mean Differences in Growth Velocity with Direct Comparison of Higher Dose vs. Lower Dose.
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pone.0133428.g003: Mean Differences in Growth Velocity with Direct Comparison of Higher Dose vs. Lower Dose.

Mentions: We identified 3 RCTS where we were able to conduct head to head comparisons of growth velocity between a higher dose and a lower dose of the same compound. [15, 29, 30] The trials were not powered to identify statistically significant differences in growth velocity with ascending ICS doses or different ICS formulations. However, we noted a consistent finding towards reduced growth velocities in the higher-dose arms relative to the lower-dose arms of the ICS, with a pooled estimate confirming greater harm (p = 0.04)with higher doses overall. (Fig 3).


Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-Analysis.

Loke YK, Blanco P, Thavarajah M, Wilson AM - PLoS ONE (2015)

Mean Differences in Growth Velocity with Direct Comparison of Higher Dose vs. Lower Dose.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507851&req=5

pone.0133428.g003: Mean Differences in Growth Velocity with Direct Comparison of Higher Dose vs. Lower Dose.
Mentions: We identified 3 RCTS where we were able to conduct head to head comparisons of growth velocity between a higher dose and a lower dose of the same compound. [15, 29, 30] The trials were not powered to identify statistically significant differences in growth velocity with ascending ICS doses or different ICS formulations. However, we noted a consistent finding towards reduced growth velocities in the higher-dose arms relative to the lower-dose arms of the ICS, with a pooled estimate confirming greater harm (p = 0.04)with higher doses overall. (Fig 3).

Bottom Line: Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)).There was evidence of a dose-response effect in three RCTs.In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.

View Article: PubMed Central - PubMed

Affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.

ABSTRACT

Background: Long-term inhaled corticosteroids (ICS) may reduce growth velocity and final height of children with asthma. We aimed to evaluate the association between ICS use of >12 months and growth.

Methods: We initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to December 2014. We selected RCTs and controlled observational studies of ICS use in patients with asthma. We conducted random effects meta-analysis of mean differences in growth velocity (cm/year) or final height (cm) between groups. Heterogeneity was assessed using the I2 statistic.

Results: We found 23 relevant studies (twenty RCTs and three observational studies) after screening 1882 hits. Meta-analysis of 16 RCTs showed that ICS use significantly reduced growth velocity at one year follow-up (mean difference -0.48 cm/year (95% CI -0.66 to -0.29)). There was evidence of a dose-response effect in three RCTs. Final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to -0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies revealed uncertainty in the association between ICS use and final adult height, pooled mean difference -0.85 cm (95% CI -3.35 to 1.65).

Conclusion: Use of ICS for >12 months in children with asthma has a limited impact on annual growth velocity. In ICS users, there is a slight reduction of about a centimeter in final adult height, which when interpreted in the context of average adult height in England (175 cm for men and 161 cm for women), represents a 0.7% reduction compared to non-ICS users.

No MeSH data available.


Related in: MedlinePlus