# Parents of a 7-year-old child with persistent asthma express concern about long-term inhaled budesonide and growth. Which response is most accurate?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391773&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Parents of a 7-year-old child with persistent asthma express concern about long-term inhaled budesonide and growth. Which response is most accurate?

## Option

1. "Switching to a leukotriene receptor antagonist like montelukast is recommended to avoid the growth-suppressing effects associated with inhaled budesonide."
2. "Inhaled corticosteroids may cause a small (~1-2 cm) reduction in adult height; growth velocity is monitored, and the lowest effective dose is used." **✔ Correct answer**
3. "Discontinuing inhaled budesonide during puberty, when growth is fastest, can prevent any potential impact on final adult height."
4. "Because inhaled budesonide acts locally in the lungs and has minimal systemic absorption, it does not affect growth in children."

**Correct answer: 2**

## Explanation

Correct (2): ICS cause a small growth velocity reduction in the first year and a modest (~1-2 cm) reduction in final adult height — much less than uncontrolled asthma or systemic steroids. Monitor growth velocity at each visit and use the lowest effective dose. (1) Effect exists but is small. (3) Oral steroids cause MUCH more suppression. (4) Stopping risks uncontrolled asthma which is worse.

## In-depth explanation

Memory Tip ICS in kids: small growth effect, but benefit > harm. Plot height every visit, use minimum effective dose, add spacer.

## Clinical scenario

Scenario 7-year-old child on budesonide 180 mcg BID for persistent asthma. Parents ask about growth effects at outpatient follow-up.

## Key concepts

- **Growth velocity** — Rate of height gain per year; tracked in pediatric ICS users to monitor effect.
- **Pediatric ICS dosing** — Lowest effective dose principle; step down when control is sustained.
- **Systemic vs inhaled steroid** — Systemic (oral/IV) far greater HPA and growth suppression than inhaled at therapeutic doses.

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