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It is generally acknowledged that asthma may have an effect on children’s growth independent of any treatment they may be receiving. The many studies showing this have been reviewed recently by Russell in this journal.1 In summary, children with moderate to severe asthma may have a characteristic pattern of slowing of prepubertal growth, delayed puberty, and a late pubertal growth spurt, with catch up to an adult height within the expected target range. It is because of this effect that difficulties can arise in trying to separate the effects of asthma from the effects of any treatment in studies of growth in children with asthma.
Oral corticosteroids
There is little doubt that oral corticosteroids such as prednisolone can have a detrimental effect on growth. Martin et al,2 in a prospective survey over 14 years, showed that children who had received oral steroids were significantly shorter than either asthmatic children who had not received steroids or non-asthmatic controls. However, this difference in height was only seen at age 14 years, and no difference was apparent by 21 years, indicating that the main effect of oral corticosteroids was to cause growth delay and affect the timing of puberty. The degree of growth retardation has been clearly linked to the frequency of oral corticosteroid use.3 However, there is also evidence that adult height can be permanently reduced in some children who have received long term oral corticosteroids for asthma.4
Inhaled corticosteroids
These were initially introduced in the 1970s and have revolutionised the management of asthma. Earlier work on the possible effects of inhaled corticosteroids on growth was contradictory and was often based on retrospective studies. Littlewood et al,5 in a report on 346 children, 81 of whom were receiving inhaled beclomethasone in doses ranging from 200 to 800 μg daily, …