To explore the effects of inhaled budesonide (i-BUD) on the growth rate and height of asthmatic children.

Databases of PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched (up to April 30, 2022), and randomized controlled trials (RCTs) and high-quality cohort studies on the effects of i-BUD on growth rate and height in asthmatic children were collected. Patients in the observation group were treated with i-BUD, and those in the control group were treated with placebo or no drug. The outcome index was the height and growth rate of the children in short- and long-term treatment with i-BUD. The Cochrane Collaboration risk of bias assessment tool was used for methodological quality assessment of RCT studies, and the Newcastle Ottawa scale (NOS) was used for quality assessment of cohort studies. Stata 11.0 software was used for the meta-analysis, and the effect sizes were expressed as mean difference (MD) with its 95% confidence interval (CI).

A total of 16 studies were included in the meta-analysis (15 RCTs and 1 cohort study), including 2 578 patients in the observation group and 2 422 in the control group. Risk of bias was low in 9 of the 15 RCTs, high in 2 RCTs, and unclear in 4 RCTs. The NOS score of the only prospective cohort study was 8 (high quality). The short-term effects of i-BUD on the growth rate of the lower limbs in children were examined in 6 studies. The exposure time to i-BUD in children in the observation group ranged from 2 to 8 weeks and the meta-analysis showed that the growth rate of lower limbs of children was significantly slower than that of children in the control group (MD=-0.18 mm/week, 95%CI: -0.24--0.13 mm/week, P<0.01). Subgroup analysis by dose showed that the growth rate of children′s lower limbs was similar in the 2 groups at 200 μg/d of inhaled i-BUD (MD=-0.10 mm/week, 95%CI: -0.25-0.05 mm/week, P=0.209); the growth rate of children′s lower limbs was significantly lower in the observation group at 400 μg/d and 800 μg/d of inhaled i-BUD than that in the control group (MD=-0.17 mm/week, 95%CI: -0.23--0.10 mm/week, P<0.01; MD=-0.34 mm/week, 95%CI: -0.48--0.20 mm/week, P<0.01). The effect of long-term (≥1 year) exposure to i-BUN on children′s height was observed in 10 studies. The meta-analysis showed that the height of children under long-time exposure to i-BUD was significantly lower than that of children in the control group (MD=-0.72 cm, 95%CI: -0.86--0.58 cm, P<0.01). The subgroup analysis according to the i-BUD exposure time showed that the height of children with 1-year, 2-years, and 4-6 years of i-BUD exposure was significantly lower than that in the corresponding control group (MD=-0.60 cm, 95%CI: -0.75--0.44 cm, P<0.01; MD=-1.30 cm, 95%CI: -1.70--0.90 cm, P<0.01; MD=-1.15 cm, 95%CI: -1.67--0.64 cm, P<0.01), but the impact of i-BUD on height of children was not significant when the average exposure time was 9.2 years (MD=-0.60 cm, 95%CI: -2.15-0.95 cm, P=0.448).

Short-term and long-term application of i-BUN both may affect the growth rate and height of asthmatic children.

Budesonide; Inhalation; Asthma; Child; Body height; Growth