Two meta-analyses have provided information on growth reduction in children who use inhaled corticosteroid (ICS) therapy for persistent asthma, with one set of findings indicating that daily use of these medications can cause a small reduction in height and the other reporting a dose-dependent reduction in growth velocity.

Both studies, conducted largely by the same researchers, including Linjie Zhang, were published by Cochrane Database of Systematic Reviews (2014;7:CD009471 and 2014;7:CD009878).

The first meta-analysis involved 25 trials and 8,471 children with mild to moderate persistent asthma (5,128 treated with ICS therapy and 3,343 controls). 

Zhang and colleagues found that compared with placebo or nonsteroidal drugs, regular use of the ICS agents studied (beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone, and mometasone) at low or medium daily doses could cause a small reduction in height (approximately 0.5 cm) in children up to age 18 years with persistent asthma, but the effect seemed minor compared with the therapeutic benefits. Growth reduction seemed to be greatest during the first year of treatment, and may depend on the specific agent used. 


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In the second meta-analysis, this one evaluating 22 trials and 3,394 children with mild to moderate asthma, Zhang’s original group and two additional researchers found a small but statistically significant difference in growth over 12 months between different ICS doses, with the results favoring use of low doses (50 to 100 micrograms).