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The effect of asthma and its treatment on growth

Correspondence to:
Correspondence to:
Dr I J M Doull
Cystic Fibrosis/Respiratory Unit, Department of Child Health, University Hospital of Wales, Cardiff CF14 4XW, UK; doullij{at}cf.ac.uk

ABSTRACT
Asthma has little, if any, significant effect on attained adult height. Untreated asthma results in a delay of puberty by approximately 1.3 years, and pubertal delay is likely to explain the majority of apparent growth failure in asthmatics. All currently available inhaled corticosteroids (ICS) result in growth suppression at conventional doses (400 µg/day of beclomethasone dipropionate equivalent), but the growth suppressive effects are relatively short lived, after which growth reverts to pretreatment levels. Younger, prepubertal children, appear more sensitive to the growth suppressive effects of ICS. Asthmatic children receiving conventional doses of ICS (400 µg/day of BDP equivalent) will attain an adult height indistinguishable from their predicted adult height (based on their mid parental height), and no different from non-asthmatics. Adult height could possibly be decreased in severe asthmatics, but this is unlikely to be greater than a 1.2 cm decrement. Recent longitudinal studies offer reassurance that at conventional doses ICS do not have significant long term effects on growth, and that their benefits consistently outweigh their side effects.

Abbreviations: BDP, beclomethasone dipropionate; BUD, budesonide; FP, fluticasone propionate; ICS, inhaled corticosteroids

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