Effects of long-term inhaled corticosteroids on growth velocity and adult height in children with asthma: a systematic review and meta-analysis

Background Inhaled corticosteroids (ICS) are the cornerstone of long-term controller therapy for childhood asthma, but their effects on growth remain controversial. Objective To evaluate the effects of long-term maintenance ICS therapy on linear growth velocity and adult or near-adult height in children with asthma. Methods We conducted a systematic review and meta-analysis in accordance with PRISMA 2020. The review was registered in PROSPERO on 27 March 2026 (CRD420261351837), after completion of the database searches on 26 March 2026 but before final study selection, data extraction, risk-of-bias assessment, and quantitative synthesis. PubMed/MEDLINE, Embase, CENTRAL, CNKI, WanFang, and SinoMed were searched from inception to March 26, 2026, with supplementary searches of ClinicalTrials.gov , WHO ICTRP, and reference lists. Eligible studies included children and adolescents with asthma receiving ICS for at least 6 months. Random-effects models were used to pool mean differences (MDs) with 95% confidence intervals (CIs). Results Thirteen studies were included, and six study reports contributed to at least one quantitative analysis. In the primary random-effects meta-analysis, ICS treatment was associated with a non-significant reduction in linear growth velocity compared with controls (MD, −0.38 cm/year; 95% CI, −0.84 to 0.07; I 2 = 64%). After excluding studies judged to be at high risk of bias, the pooled estimate became statistically significant (MD, −0.59 cm/year; 95% CI, −1.10 to −0.07), suggesting a possible small reduction in linear growth velocity rather than definitive evidence of an effect. A reduction was observed in school-age children (MD, −0.50 cm/year; 95% CI, −0.96 to −0.04), although age-specific differences remained uncertain. Limited long-term evidence suggested a small reduction in adult height (MD, −1.20 cm; 95% CI, −1.90 to −0.50). Conclusion In the primary analysis, long-term maintenance ICS therapy did not demonstrate a statistically significant reduction in linear growth velocity in children with asthma. However, sensitivity analysis excluding studies at high risk of bias suggested a possible small reduction. Evidence regarding adult height was limited and derived predominantly from one long-term follow-up study. These findings should therefore be interpreted cautiously and balanced against the established benefits of ICS for asthma control.