A METAANALYSIS OF THE EFFECT OF ORAL AND INHALED CORTICOSTEROIDS ON GROWTH

This analysis summarizes studies comparing attained heights with expected heights of children with asthma treated with inhaled or oral corticosteroids. The possible moderating effects of treatment duration, and dosage and asthma severity are also examined. A preliminary database of 95 articles rendered 21 includable studies representing 810 patients with asthma, which yielded 29 tests of the corticosteroid-growth effect. Statistical integration of the results of these studies revealed a significant but small tendency for corticosteroid-growth effect. Statistical integration of the results of these studies revealed a significant but small tendency for corticosteroid therapy in general to be associated with diminished final height (Z = 2.328, p = 0.01, mean r = -0.023). However, this effect varied for the specific drugs under consideration. As expected significant weak growth impairment was observed for prednisone (Z = 2.137, p = 0.0164, mean r = -0.295) and ''other oral corticosteriods'' (Z = 9.107, p = 2.44E-18, mean r = -0.260). On the other hand, a significant moderate tendency was observed for inhaled beclomethasone dipropionate therapy to be associated with attaining normal stature (Z = 7.395, p = 2.17E-13, mean r = +0.43). There was no statistical evidence for beclomethasone diproprionate therapy to be associated with growth impairment at higher doese, for longer therapy durations, or among patients with more severe asthma. This meta-analytic integration indicated that available studies of inhaled beclomethasone dipropionate therapy do not show an association between its use and the adverse effect of diminshed stature.