BMJ 1998;316:668-672 ( 28 February )

General Practice

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland

C McCowan, project officer, National Asthma Campaign,  R G Neville, senior lecturer in general practice,  G E Thomas, lecturer in statistics,  I K Crombie, reader in epidemiology,  R A Clark, consultant chest physician,  I W Ricketts, reader in computer studies,  A Y Cairns, lecturer in computer studies,  F C Warner, research secretary in general practice,  S A Greene, consultant paediatric endocrinologist,  E White, health visitor. 

Tayside Centre for General Practice, University of Dundee, Dundee DD2 4AD

Correspondence to: Mr McCowan c.mccowan{at}dundee.ac.uk

Objective: To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group.
Design: 4 year follow up of a cohort of children aged 1-15. 
Setting: 12 general practices in the Tayside region of Scotland.
Subjects: 3347 children with asthma or features suggestive of asthma registered with the general practices.
Main outcome measures: Height and weight standard deviation scores.
Results: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P<0.001 for both). Children who were receiving >= 400 µg daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P=0.002, for height and -0.58 (0.94), P=0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P=0.003). However, no other children with asthma showed growth impairment.
Conclusion: Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.

Key messages

  • Social deprivation has an adverse effect on the height and weight of children irrespective of any disease process

  • Neither asthma nor its treatments had any noticeable effect on the height and weight of most of the children in this primary care study

  • Children who received high doses of inhaled corticosteroids and used hospital services for asthma were shorter and lighter than their contemporaries after social deprivation was allowed for

  • Children receiving high doses of inhaled corticosteroids had lower than normal growth rates



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Neither asthma nor its treatment adversely affects growth
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