Impact of inhaled and intranasal corticosteroids on the growth of children

Since inhaled and intranasal corticosteroids may be systemically bioavailab le, risk of growth suppression cannot be ruled out in children treated with these compounds. The mechanisms by which exogenous corticosteroids can cau se growth suppression may be multifactorial, involving influences on growth hormone secretory profiles and insulin-like growth factor-I activity, dire ct effects on the epiphyseal growth plate, and effects on bone and collagen turnover. When studies on growth in children treated with inhaled and intr anasal corticosteroids are interpreted, it is important to discriminate bet ween data on the final outcome of growth (adult height) and data on growth rate. No firm conclusions can be drawn on adult height from the available d ata. While the data on children treated with inhaled corticosteroids appear reassuring, there are no peer-reviewed studies on the final height of chil dren treated with intranasal corticosteroids. The possibility of additive e ffects on the final height or growth rate of children receiving intranasal plus inhaled corticosteroids has also not been studied. When assessing the risk of growth rate suppression, specific corticosteroids, doses and inhale r systems must be evaluated separately. Standard paediatric doses of inhale d corticosteroids (budesonide 200 to 400 mu g/day delivered from a metered dose inhaler with a spacer, dry powder budesonide 200 mu g/day or dry powde r fluticasone propionate 200 mu g/day) do not affect growth rate when a twi ce daily administration regimen is used. The risk of growth rate suppressio n in children treated with inhaled budesonide depends on the dosage and may become significant with 800 mu g/day administered with a spacer, or with 4 00 mu g/day administered with a dry powder device. When high doses of inhal ed corticosteroids are used, the risk of adverse effects on growth rate can be reduced by once daily dosage in the morning. In fact, intranasal mometa sone furoate 100 and 200 mu g from an aqueous pump spray and dry powder bud esonide 200 and 400 mu g once daily in the morning have been found not to a ffect growth rate. Sensitivity to adverse effects on growth rate may vary b etween individuals. If growth suppression is detected, 'catch-up growth' ma y be expected when the dose of the inhaled or intranasal corticosteroid is reduced or other treatment modalities an introduced. Inhaled or intranasal corticosteroids should not be withheld from children with asthma or rhiniti s. Topical corticosteroids should be given in doses that control disease sy mptoms; however, height measurements should be performed regularly in child ren receiving corticosteroids.