Do inhaled corticosteroids impair long-term growth in prepubertal cystic fibrosis patients?

Abstract

Despite absence of clear proof of efficacy, the use of inhaled corticosteroids (ICS) is widespread in cystic fibrosis (CF) patients. Therefore, the effect of ICS on lung function and other clinical variables was studied in 27 prepubertal CF children with mild to moderate lung disease. In a prospective double-blind case-controlled study, fluticasone propionate 500 microg or placebo were administered twice daily during 12 months. The mean (standard error of the mean, SEM) patient age was 8.2 (0.6) years in the placebo group and 9.0 (0.5) years in the fluticasone group. The mean (SEM) forced expiratory volume in 1 s (FEV(1)) was 91% (4%) in the placebo group and 86% (4%) in the fluticasone group. There was no statistically significant difference in the evolution of lung function and the number of respiratory exacerbations between groups. However, longitudinal growth in fluticasone patients was significantly slower than in placebo patients: 3.96 (0.29) cm versus 5.49 (0.38) cm [p<0.005, analysis of variance (ANOVA)] over the 12-month study duration. This resulted in a significant change in height standard deviation score (SDS) of -0.38 (0.09) in the fluticasone group versus -0.01 (0.07) in the placebo group (p<0.003, ANOVA). No catch-up growth was noted 1-2 years after discontinuation of inhaled steroids. The use of high-dose ICS in CF patients with mild lung disease may lead to persistent growth impairment.

Inhaled corticosteroids and lower lung function decline in young children with cystic fibrosis

“…As a group, children with CF already have decreased growth velocity [8,9] and this could be worsened by ICS treatment. In addition, there is evidence that catch-up of growth after treatment with alternate-day oral steroids or ICS may not fully occur in patients with CF [10,11].…”

Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis: A European consensus

“…However, a recent study showed a significant slowing in linear growth in pre-pubertal children receiving drypowder fluticasone propionate over 12 months compared to placebo [94].…”

Anti-inflammatory Therapies for Cystic Fibrosis-Related Lung Disease

“…Conclusions from these studies are limited due to relatively small study populations and short observation periods. Most dosing regimens used in these trials were extrapolated from use in patients with asthma, which may be inadequate to penetrate the large amount of mucus present in the CF lung, although larger doses may be associated with adverse effects [66]. Although clinical trials have failed to demonstrate benefit from ICS, preliminary results from an analysis of observational data from CF patients aged 6-12 years participating in the Epidemiologic Study of Cystic Fibrosis revealed that the institution of ICS was associated with a marked reduction in subsequent rate of FEV1 decline [67].…”