Cochrane for Clinicians

Putting Evidence into Practice

Effects of Inhaled Corticosteroids on Growth in Children with Persistent Asthma


Am Fam Physician. 2020 Oct 1;102(7):404-405.

Author disclosure: No relevant financial affiliations.

Clinical Question

Do different inhaled corticosteroids have different impacts on growth in children with asthma?

Evidence-Based Answer

Inhaled fluticasone (Flovent; 200 mcg per day) is associated with a greater linear growth velocity (mean difference [MD] = 0.81 cm per year; 95% CI, 0.46 to 1.16; one study, 23 participants) when compared with beclomethasone (400 mcg per day; an equivalent dose). (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Fluticasone via Diskus inhaler (200 mcg per day) is associated with a greater increase in height (MD = 0.97 cm; 95% CI, 0.62 to 1.32; two trials, 359 participants) over 20 weeks to 12 months compared with budesonide (Rhinocort) via turbuhaler (400 mcg per day). (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Budesonide via Easyhaler is associated with a greater increase in height over six months (MD = 0.37 cm; 95% CI, 0.12 to 0.62; one trial, 229 participants) when compared with budesonide via turbuhaler.1 (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Practice Pointers

Asthma affects 19 million adults and 6.2 million children in the United States.2 Between 2008 and 2013, asthma contributed to $50 billion in direct medical costs and $3 billion in indirect costs from missed school and work.3 The Global Initiative for Asthma (GINA) recommends the use of inhaled corticosteroids for all children with asthma, except for those with the mildest form (when inhaled corticosteroid use is optional).4 Inhaled corticosteroids are associated with growth delays. A randomized controlled trial found that four years of budesonide use was associated with a 1.2-cm loss in final adult height, and a meta-analysis of two observational studies showed that inhaled corticosteroid use was associated with a 0.85-cm loss in height.5 Poorly controlled asthma also

Author disclosure: No relevant financial affiliations.


show all references

1. Axelsson I, Naumburg E, Prietsch SO, et al. Inhaled corticosteroids in children with persistent asthma: effects of different drugs and delivery devices on growth. Cochrane Database Syst Rev. 2019;(6):CD010126....

2. Centers for Disease Control and Prevention. Most recent national asthma data. Reviewed March 24, 2020. Accessed March 6, 2020.

3. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008–2013. Ann Am Thorac Soc. 2018;15(3):348–356.

4. Global Initiative for Asthma. 2020 GINA Report, global strategy for asthma management and prevention, 2019. Accessed March 6, 2020.

5. Loke YK, Blanco P, Thavarajah M, et al. Impact of inhaled corticosteroids on growth in children with asthma: systematic review and meta-analysis. PLoS One. 2015;10(7):e0133428.

6. Zhang L, Lasmar LB, Castro-Rodriguez JA. The impact of asthma and its treatment on growth: an evidence-based review. J Pediatr (Rio J). 2019;95(suppl 1):10–22.

7. National Asthma Education and Prevention Program. Asthma care quick reference: diagnosing and managing asthma. Expert panel report 3. Accessed March 6, 2020.



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