[Inhaled corticoids and systemic secondary effects: controversies].

Area of Science:

• Pulmonology
• Endocrinology
• Pediatrics

Background:

• Systemic effects of inhaled corticosteroids (ICS) are widely studied but yield conflicting results.
• Previous corticosteroid use complicates the evaluation of ICS-specific side effects.
• Secondary effects on adrenal function and bone health are challenging to quantify.

Purpose of the Study:

• To clarify the systemic impact of inhaled corticosteroids.
• To differentiate ICS effects from those of prior systemic corticosteroid exposure.
• To evaluate effects on adrenal function, bone health, and growth in asthmatic children.

Main Methods:

• Review of existing literature comparing systemic effects of ICS.
• Analysis of studies reporting secondary biological effects, particularly on adrenal function and bone.
• Examination of growth velocity in asthmatic children during the first year of ICS treatment.

Main Results:

• Contradictory findings exist regarding the systemic impact of ICS.
• High doses of ICS may cause subclinical adrenal effects, but clinical significance is often absent.
• Growth velocity in children may be temporarily reduced in the first year of ICS treatment, but adult height is unaffected.
• Bone density changes are difficult to demonstrate definitively.

Conclusions:

• The systemic effects of ICS are confounded by prior corticosteroid use.
• Clinical significance of observed biological effects, such as adrenal suppression, is often minimal.
• ICS have limited impact on long-term growth and bone health in asthmatic children.
• Further research is needed to isolate the specific systemic effects of ICS.