Main results : Forty-seven primary studies with 13,139 participants met the inclusion criteria. Medium-term use of inhaled corticosteroids (longer than two months and up to six months) resulted in a small improvement in FEV 1 in some studies. Long-term use of inhaled corticosteroids (longer than six months) did not significantly reduce the rate of decline in FEV 1 in patients with COPD (weighted mean difference [WMD] = mL per year with inhaled corticosteroids over placebo; 95% confidence interval [CI], − to ; 2,333 participants). There was no statistically significant effect on mortality in patients with COPD (odds ratio [OR] = ; 95% CI, to ; 8,390 participants). Long-term use of inhaled corticosteroids reduced the mean rate of exacerbations in those studies where pooling of data was possible (WMD = − exacerbations per patient per year; 95% CI, − to −; 2,586 participants). Inhaled corticosteroids slowed the rate of decline in quality of life, as measured by the St. George's Respiratory Questionnaire (WMD = − units per year; 95% CI, − to −; 2,507 participants). Response to inhaled corticosteroids was not predicted by oral steroid response, bronchodilator reversibility, or bronchial hyperresponsiveness in patients with COPD. There was an increased risk of oropharyngeal candidiasis (OR = ; 95% CI, to ; 4,380 participants) and hoarseness. The few long-term studies that measured bone effects generally showed no major effect on fractures and bone mineral density over three years.
Another common fear about corticosteroids is that they will cause growth suppression in children. To date, many studies have been done that prove that corticosteroids do not stunt a child's growth. Six years of ongoing studies in children and adolescents who used inhaled corticosteroids show that the speed of growth may be slowed by about 1 cm. over one year in children. However, these children catch up and do attain their full adult height. In some studies, these children grew even taller than their siblings. Interestingly, poorly controlled asthma can actually contribute to growth suppression.