Director, Division of Allergy and Immunology, West Virginia University Children's Hospital, Morgantown, West Virginia; Professor of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia.
Ann Allergy Asthma Immunol. 2016 Dec;117(6):595-600. doi: 10.1016/j.anai.2016.07.043.
Both slowed growth in children and reduced bone mineral density (BMD) are systemic effects of corticosteroids, and there is concern about the degree to which these systemic effects affect growth and BMD.
To engage in a data-driven discussion of the effects of inhaled corticosteroids (ICSs) on growth in children and BMD.
Articles were selected based on their relevance to this review.
Studies of ICSs in children in which growth was a secondary outcome have revealed slowed growth associated with low doses of budesonide, fluticasone propionate, and beclomethasone dipropionate. In the study of budesonide, the effect was permanent, and in the study of fluticasone propionate, the effect was long-lasting, but it is unclear whether the effect was permanent. However, the results of studies in which growth was the primary outcome were mixed. Slowed growth was detected in a study of beclomethasone dipropionate; however, slowed growth was not detected in a study of ciclesonide or flunisolide. A decrease in BMD acquisition in children was associated with high doses but not low to medium doses of ICSs. In adults, there was a dose-related effect of ICSs on BMD. Both higher daily dose and larger cumulative dose were associated with increased bone density loss.
Because of the systemic effects on growth and bone health, children should be monitored for growth using stadiometry every 3 to 6 months and BMD should be monitored yearly in patients being treated with high doses of ICSs.
儿童生长缓慢和骨密度降低（BMD）都是皮质类固醇的全身效应，人们担心这些全身效应会在多大程度上影响生长和 BMD。
就吸入性皮质类固醇（ICSs）对儿童生长和 BMD 的影响进行数据驱动的讨论。
根据与本综述相关的内容选择文章。
对儿童ICS 生长作为次要结果的研究表明，与布地奈德、丙酸氟替卡松和二丙酸倍氯米松低剂量相关的生长缓慢。在布地奈德的研究中，这种影响是永久性的，在丙酸氟替卡松的研究中，这种影响是持久的，但尚不清楚这种影响是否是永久性的。然而，以生长为主要结果的研究结果喜忧参半。在二丙酸倍氯米松的研究中发现了生长缓慢；然而，在环索奈德或氟尼缩松的研究中并未发现生长缓慢。在儿童中，BMD 获得的减少与高剂量但不是低至中剂量的 ICSs 相关。在成年人中，ICSs 对 BMD 有剂量相关的影响。较高的日剂量和较大的累积剂量均与骨密度丢失增加相关。
由于生长和骨骼健康的全身效应，应每 3 至 6 个月使用身高计监测儿童的生长情况，并且应在高剂量 ICSs 治疗的患者中每年监测 BMD。
