Continuous inhaled corticosteroid usage associated with reduced height in children at 6 years: BMJ

Denmark: A recent study published in the journal Thorax, an official journal of the British Thoracic Society, suggests that inhaled corticosteroid usage is associated with reduced height in children at six years of age who continued the treatment in the sixth year of life.

Inhaled corticosteroids (ICS) are used to treat persistent asthma in children. The long-term use of ICS is associated with adverse effects on bone, including a reduction in bone mineral content, risk of osteoporosis, and fracture.[1] There is a scarcity of data available from controlled trials to document the long-term consequences of ICS corticosteroids with the availability of follow-up periods.

Asja et al. and the team analyzed this area in their study to determine the long-term consequences of ICS on height and bone mineral content of children up to 6 years of age. The bone mineral content was measured from dual-energy X-ray absorptiometry (DXA) scans done at the age of 6 years.[2] These were the primary outcomes measured in the study.

The method of the study included data of 1111 children from two Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) cohorts. The ICS usage was registered, with the calculated cumulated dose from birth to 6 years of age.

The key points from the study include:

• 84 % of the total of 1111 children from the cohorts had valid data on height measurement at the age of 6 years.

• Nearly 792 children had a DXA scan.

• A cumulated ICS dose equivalent to or above ten weeks of standard treatment was administered to 31 % of children before the age of 6 years. The minimum treatment duration was of 10 weeks.

• An inverse correlation was observed between the use of ICS and height, -0.26 cm from 0 to 6 years of age as per 1-year standard treatment with a p-value of 0.006.

• The effect was prominent and significant in children between 5 to 6 years of age with ongoing treatment. The p-value was 0.004 and the height was -0.31 cm.

• These changes were not significant in children who stopped the ICS treatment one year before the age of 6 years. In this case, the p-value was 0.64 with a height of -0.09 cm.

• ICS usage and BMC content have no significant association at the age of 6 years.

The same team of authors has done an observational study to determine the side effects of ICS on body mass index (BMI), adiposity rebound (AR), and body composition published in the American Journal of Respiratory and Critical Care Medicine. The study did not associate height and DXA scan, so the same was assessed in the present study.[3]

The present study associates the long-term side effects of ICS on height and bone mineral density which have been rarely studied. The study marks the importance of addressing future clinical trials.

References :

1. Editorial. Limited side effects of asthma treatment on growth and bone health in children.Marie Standl Thorax 2022; 77 741-741 Published Online First: Mar 04, 2022

2. Kunøe A, Sevelsted A, Chawes BLK, Stokholm J, Krakauer M, Bønnelykke K, Bisgaard H. Height, and bone mineral content after inhaled corticosteroid use in the first six years of life. Thorax. 2022 Aug;77(8):745-751. DOI: 10.1136/thoraxjnl-2020-216755. Epub 2022 Jan 19. PMID: 35046091.

3. Kunøe A, Sevelsted A, Chawes BL, Stokholm J, Eliasen A, Krakauer M, Bønnelykke K, Bisgaard H. Associations between Inhaled Corticosteroid Use in the First 6 Years of Life and Obesity-related Traits. Am J Respir Crit Care Med. 2021 Sep 15;204(6):642-650. DOI: 10.1164/rccm.202009-3537OC. PMID: 33975528.