Effect of inhaled beclomethasone dipropionate and budesonide on growth in children with asthma

The decision to prescribe a medication long term to a child must be made with care because of possible detrimental effects on normal development. Current asthma guidelines advocate the use of inhaled corticosteroids in children with moderate or severe asthma (1,2). Corticosteroids administered systemically can impair linear growth (3,4) and height (5), possibly as a result of subnormal adrenal androgen and/or growth hormone (GH) production (6) and direct effects on bone and connective tissue growth (7). Although administering corticosteroids via inhalation is associated with fewer systemic effects compared with oral administration, there is recent evidence that consistent administration of inhaled corticosteroids can affect growth (8,9). The inhaled corticosteroids used most commonly in children with asthma are beclomethasone dipropionate (BDP) and budesonide. Following a brief review of mechanisms by which corticosteroids suppress growth, this article will summarise data pertaining to the effect of these two agents on growth in children with asthma.