What adverse effect is particularly significant for children on long-term fluticasone therapy?

The significant adverse effect of long-term fluticasone therapy in children is adrenal suppression. Fluticasone is a corticosteroid used to control inflammation in conditions such as asthma and allergic rhinitis. While corticosteroids can be effective in managing these conditions, they also have a potential downside—particularly when used chronically or at higher doses, they can suppress the hypothalamic-pituitary-adrenal (HPA) axis.

In children, whose bodies are still developing, this suppression can lead to disorders related to adrenal insufficiency, such as failure to thrive, stress response issues, and other systemic complications. This effect is especially concerning because it may impede normal growth and development in pediatric patients. Thus, monitoring for adrenal function is critical in children receiving prolonged corticosteroid therapy.

The other options may not have the same level of concern linked to long-term use of fluticasone in children. Weight gain, hyperactivity, and increased appetite can sometimes be observed with steroid use, but these are generally less severe or not as frequently reported compared to adrenal suppression, making the latter a more significant point of focus for healthcare providers managing long-term therapy in young patients.