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Inhaled corticosteroid and children’s growth
  1. Andrew Bush1,2
  1. 1Department of Respiratory Paediatrics, National Heart & Lung Institute, Imperial College London, London, UK
  2. 2Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  1. Correspondence to Professor Andrew Bush, Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; a.bush{at}

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No one ever died because they fell 1 cm short of their potential final height, but many families understandably worry about the side effects of inhaled corticosteroids (ICS), and may stop ICS treatment in consequence. It is important to state at the outset that reduced linear growth in a child with asthma should not uncritically be attributed to ICS, but should rather lead to a critical re-evaluation of the child. Atopy per se may lead to delay in puberty and a more prolonged prepubertal growth deceleration1; poorly controlled asthma, as with any chronic disease, may lead to growth failure2; and coincidental disease such as growth hormone deficiency should be considered. Indeed, it has been argued that accurate height measurement, with the results plotted on an appropriate centile chart is an essential part of the paediatric asthma clinic.3 Children still do die of asthma attacks, which may result from non-adherence to treatment.4 So it is essential that all professionals treating children with asthma understand the risks of side effects of ICS, and also their benefits, and are able to give balanced and credible reassurance to families.

Among the more common family worries about ICS are their effects on final height. There have been numerous ultrashort-term studies measuring tibial length as a surrogate for change in height over time using knemometry, and short-term studies using direct measurement of height, usually using stadiometry.5 ,6 They all illustrate the dictum of the late Professor David Flenley that you cannot do a 5 year study in less than 5 years. However, at long last, and the nearest we are likely to get to a definitive answer, has come from the Children's Asthma Management Program (CAMP) study in the USA. The original question that the …

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