Abstract 767 Poster Session IV, Tuesday, 5/4 (poster 47)

Objective: To conduct a meta-analysis of randomized controlled trials of inhaled steroid therapy in children with asthma to determine the existence of a significant delay in linear growth

Data Sources: MEDLINE (1966-1998), EMBASE (1980-1998), and CINAHL (1982-1998) database searches, along with bibliographies of included studies were conducted to identify randomized controlled trials of inhaled steroid therapy in children with asthma that evaluated the outcome of linear growth.

Study Selection: Studies were included if they met the following criteria: Subjects aged 0 to 18 years at time of entry, clinical diagnosis of asthma, no inhaled or oral steroids at the time of entry into the study, randomization to treatment with inhaled Beclomethasone, Budesonide, Flunisolide, Fluticasone, or Triamcinolone vs. a non-steroidal inhaled control for a minimum of 3 months, single or double-blind, outcome convertible to linear growth velocity

Data Extraction: Trial methodological quality was assessed independently by 2 reviewers; outcome was extracted as the change in height over time, reported as the regression coefficient of linear growth over time

Data Synthesis: 3 studies with 283 subjects that evaluated the effect of inhaled steroid therapy on linear growth in children with asthma were combined and showed a decrease in linear growth of 1.544 cm per year (confidence interval [CI], 1.153 to 1.936). Subgroup analysis by inhaled steroid type was not performed due to all included studies using inhaled Beclomethasone. Sensitivity analysis, reviewing the effects of methodological quality, mode of inhaled steroid delivery, and statistical model used (random vs. fixed effects model), maintained similar conclusions.

Conclusions: This meta-analysis suggests that the use of inhaled steroids in children with asthma results in a statistically significant decrease in linear growth. This finding is not affected by mode of delivery of the inhaled steroid. It is unknown if his decreased growth velocity is sustained, plateaus, or even reverses when inhaled steroids are given for more than 54 weeks, or whether the absolute height difference when reaching adult height is of clinical significance