Poor Growth: While poor growth can result from ICS, poorly controlled asthma can also lead to poor growth in children. In general, low and medium doses of ICS are potentially associated with small, non-progressive but reversible declines in growth of children. As a result, you and your asthma provider should not only carefully monitor growth, but try to use the lowest possible dose that gets good control of your child's asthma. You must weigh the potential benefits of good asthma control with the small but real possible side effect of slowed growth.
There is some evidence that quadrupling the maintenance dose of inhaled corticosteroids, 73 or treating with a high dose of inhaled corticosteroids, 74 , 75 , 76 reduces the severity of asthma flare-ups. For patients taking inhaled corticosteroid/long-acting beta 2 agonist combinations, this can be achieved by adding a separate high-dose inhaled corticosteroid inhaler to the patient’s usual maintenance treatment for 7–14 days. This strategy may be useful for patients who experience clinically important side-effects with oral corticosteroids, but may not be suitable for patients who cannot afford the extra medicine or who experience hoarseness with high dose inhaled corticosteroid.