Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-AnalysisReport as inadecuate




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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.



Author: Yoon Kong Loke , Patricia Blanco, Menaka Thavarajah, Andrew M. Wilson

Source: http://plos.srce.hr/



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