for the main comparison.
| Inhaled corticosteroids compared with placebo or non‐steroidal drugs for children with persistent asthma: effects on growth | ||||||
|
Patient or population: children up to 18 years of age with persistent asthma Settings: outpatient Intervention: inhaled corticosteroids Comparison: placebo or non‐steroidal drugs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Mean difference (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo or non‐steroidal drugs | Inhaled corticosteroids1 | |||||
| Linear growth velocity in first year of treatment (cm/y) | Mean linear growth velocity ranged across control groups from 5.5 to 8.5 cm/y | Mean reduction in linear growth velocity was 0.48 cm/y | ‐0.48 cm/y (‐0.65 to ‐0.30) less growth in the ICS group | 5717 (14 trials) |
⊕⊕⊕⊝ moderate2, 3 | |
| Change from baseline in height over first year of treatment (cm) | Mean change from baseline in height over a 1‐year period ranged across the control groups from 4.7 to 8.6 cm/y | Mean reduction in change from baseline in height over a 1‐year period was 0.61 cm | ‐0.61 cm (‐0.83 to ‐0.38) less growth in the ICS group | 3275 (15 trials) |
⊕⊕⊕⊝ moderate2,3 | |
| Change in height standard deviation score (SDS) in first year of treatment | Mean change in height SDS score across control groups from ‐0.09 to 0.5 | Mean reduction in change in height SDS score was 0.13 | ‐0.13 (‐0.24 to ‐0.01) less growth in the ICS group | 258 (4 trials) |
⊕⊕⊕⊝ moderate2,3 | |
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval. | ||||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Inhaled corticosteroids included beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone propionate and mometasone fumarate.
2A considerable number of included trials did not report the methods of random sequence generation and allocation concealment and had high withdrawal rates, especially in the control groups (deduct 1 point for limitations)
3Significant heterogeneity was noted in results across studies that may be expected because of differences in the molecule, daily dose and age group across trials. However, all trials showed negative effects of ICS on growth, suggesting that the heterogeneity is quantitative but not qualitative and may not significantly affect the conclusions of this review (do not deduct point for inconsistency)