Reinforce that asthma is a potentially disabling and seriousdisease for which optimal control is the first priority. ICStherapy, currently the most effective treatment for persistentasthma and the only therapy demonstrated to reduce the riskof death fromasthma, offers relatively targeted corticosteroidexposure with a high benefit/risk ratio, particularly whencompared with oral corticosteroid treatment at equally effectivedosages. Acknowledge that modest slowing of growth is apossible effect of treatment, but is less significant to thechild’s well being than freedom from asthma symptomsand, in severe cases, prevention of life-threatening episodes.50Reassure that with proper monitoring, drug selection, anddose-adjustment, the effects of ICSs on growth can be prevented,or detected and minimized, and that the best dataavailable indicate a very mild degree (eg, <1 inch) of potentiallong-term height reduction and eventual adult height withinthe normal range. For health care providers, concern for andmonitoring of potential growth-suppressing effects of ICSsshould include toddlers and be increased for childrenrequiring high ICS dosages, demonstrating a pattern of delayedgrowth (eg, short stature owing to constitutionalgrowth delay), or receiving other steroid treatments or othermedications (eg, stimulants) with potential growthsuppressingeffects. Furthermore, because the systemic effectsof ICSs correlate with consistency of exposure as well asdosage, exceptional adherence to prescribed ICS dosing is,in my experience, a shared attribute of most children whoexperience ICS-induced growth suppression and an additionalfactor influencing the closeness of follow-up forgrowth assessment and dosage reduction opportunities.
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