Use of inhaled corticosteroids (ICS) in young children was associated with a slightly reduced height at the age of six but only in those who continued treatment into their sixth year, in a prospective study from Denmark.

ICS usage was documented in two cohorts of children from the Copenhagen Prospective Studies on Asthma in Childhood up to the age of six years. There were 411 children in the first study which commenced in 2000 and 700 children in the latter study which began in 2010.

Height was measured regularly until age six and dual energy X-ray absorptiometry (DXA) scans were carried out at ages six to seven years to calculate bone mineral composition.

The cumulative dose of ICS was calculated. ICS usage was categorised into four groups. The reference group included those children with no use or a cumulative ICS dose ≤ 10 weeks of treatment with standard ICS dosage (400 mcg budesonide daily or equivalent). The remaining children were divided into tertiles of increasing ICS exposure. 

The primary outcomes were height and bone mineral content at age six. 

Overall, 930 children (84%) from the two cohorts had had a height measurement at six years and 792 (71%) had had a DXA scan.

Of the 930 children with height measured at age six, 291 (31%) had received a cumulative ICS dose equivalent to > 10 weeks of standard treatment before the age of six.

Those in the group with highest exposure had received a cumulative ICS dose corresponding to a median of 2.9 years of standard treatment.

A total of 111 children were identified as being on treatment between the ages of five and six.

• After adjusting for confounders, such as gestational age and length and weight at birth, the cumulative ICS dose as a continuous measure from 0 to six years was inversely associated with height at age six: -0.26 cm (95% CI: −0.45 to -0.07; P = 0.006) height difference per year of standard treatment

• However, this was mainly driven by children still treated after age five: −0.31 cm (95% CI: −0.52 to −0.10; P = 0.004) height difference per year of standard treatment

• There was no significant association for those not treated after age five: −0.09 cm (95% CI: −0.46 to 0.28; P = 0.64) height difference per year of standard treatment

• In the subgroup of children having received the largest cumulative dose of ICS, and still receiving ICS in the sixth year, there was a height difference of -1.16 cm (95% CI: −1.94 to −0.38; P = 0.004)

There was no association between ICS use and bone mineralisation at age six.

The study authors conclude:

‘We found evidence that ICS use was associated with reduced height at age six years but only in children with continued treatment in the sixth year of life. We found no effect on bone mineral content.’

‘A subgroup of children with continued use of ICS and the largest cumulative doses showed evidence of a minor height difference. The height development of this group of children into adulthood should be explored,’ they add.

For young children the use of ICS seems to have no adverse effects on growth at age six providing it has been stopped by age five.

Dr Peter Saul