Title. Inhaled corticosteroids and systemic adverse effects in asthmatic children and adolescents.
Background. Inhaled corticosteroids (ICS) are well established as first-line maintenance therapy for persistent asthma. Compared to oral corticosteroids, ICS are considered as safe therapeutic agents with a low risk of adverse drug reactions. However, studies have emphasized the possibility of adrenal suppression, growth retardation and effects on bone metabolism in asthmatic children and adolescents treated with ICS.
Methods. A systematic search was performed using Pubmed and Embase.
Results. Clinical significant adrenal suppression and adrenal crisis have been described at doses above 400 microgr a day, particularly with fluticasone. Studies have found a reduction in growth velocity associated with 300-400 microgr a day and higher doses. This growth retardation is transient and there is no effect on final adult height. Exposure to ICS does not increase the fracture risk in children or adolescents. More studies on effects of high dose ICS treatment on bone are needed to further address this issue.
Conclusions. The benefits of ICS are well established and far exceed any systemic adverse effects. It is however important to be aware of the potential risks associated with high dose ICS treatment, and clinical safety guidelines should be followed carefully.