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The use of inhaled corticosteroids in children with asthma
H William Kelly1, Hengameh Heidarian-Raissy
1Department of Pediatrics, Children's Hospital of New Mexico, ACC Building, 3rd Floor, 2211 Lomas Boulevard NE, Albuquerque, NM 87131-5311, USA. hwkelly@salud.unm.edu
Insights
Inhaled corticosteroids (ICSs) are effective for childhood asthma control in young children. Clinical trials confirm their safety and efficacy, supporting current treatment guidelines.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Inhaled corticosteroids (ICSs) are the primary long-term controllers for childhood asthma.
- Evidence supports the efficacy and safety of ICS therapy in infants and young children (6 months to 4 years).
Purpose of the Study:
- To review the efficacy and safety data of inhaled corticosteroids (ICSs) in infants and young children.
- To discuss appropriate delivery methods and long-term management strategies for ICS therapy in this age group.
Main Methods:
- Review of controlled clinical trial data on ICS efficacy and safety in children aged 6 months to 4 years.
- Analysis of delivery methods, including nebulizer suspensions and metered-dose inhalers with valved holding chambers.
- Evaluation of safety data, including growth effects and long-term outcomes.
Main Results:
- ICS therapy is effective for long-term asthma control in young children.
- Nebulizer suspensions and metered-dose inhalers with valved holding chambers are suitable delivery methods.
- A transient growth delay (0.5-2 cm) in prepubescent children does not impact adult height.
- ICSs demonstrate a favorable safety profile at recommended dosages.
Conclusions:
- Inhaled corticosteroids are safe and effective for managing asthma in infants and young children.
- Delivery method selection should consider child cooperation and clinician choice.
- Dosage reduction and therapy cessation are recommended once asthma control is achieved or remission occurs.
Abstract:
The inhaled corticosteroids (ICSs) are the most effective long-term controllers for the treatment of childhood asthma. There is now substantial controlled clinical trial data to support the efficacy and safety of ICS therapy in infants and young children (6 months to 4 years of age). These data support the use of nebulizer suspension or metered-dose inhalers with valved holding chambers as effective forms of delivery in this age group. Currently, selection of delivery method depends on the comfort of the parent and the cooperation of the child, as well as on which drug the clinician chooses. The ICSs have a favorable safety profile when administered in currently recommended dosages. A transient 0.5- to 2-cm growth delay occurs in prepubescent children but does not appear to affect attainment of predicted adult height. Long-term trials support the existing recommendations of lowering dosage once control is achieved and stopping therapy when the child's asthma is in remission.