Corticosteroids in respiratory diseases in children

Area of Science:

• Pediatric Pulmonology
• Pharmacology
• Immunology

Background:

• Corticosteroids (CS) are widely used in pediatric lung diseases, administered systemically or via inhalation.
• Mechanisms of action for CS in pulmonary diseases are not fully understood, involving genomic and non-genomic pathways.
• CS demonstrate proven benefits in asthma, croup, allergic bronchopulmonary aspergillosis, and subglottic hemangioma.

Purpose of the Study:

• To review recent advancements in the application of corticosteroids for pediatric lung conditions.
• To evaluate the efficacy and safety profiles of corticosteroids in various pediatric respiratory diseases.
• To discuss emerging trends and controversies surrounding corticosteroid use in children.

Main Methods:

• Literature review of recent advances in pediatric lung disease treatment with corticosteroids.
• Analysis of clinical evidence for corticosteroid efficacy and adverse effects in different pediatric respiratory conditions.
• Synthesis of current recommendations and controversies regarding corticosteroid use.

Main Results:

• CS are beneficial in asthma, croup, ABPA, and subglottic hemangioma, but their use is controversial in bronchiolitis, CF, and BPD.
• Empirical use of CS occurs in conditions like TB, ILD, and ARDS without clear evidence of benefit.
• Recent developments include flexible inhaled CS/LABA use in asthma, limited oral CS efficacy in preschool wheeze, restricted systemic dexamethasone for BPD, and pulsed methylprednisolone for ABPA/CF.

Conclusions:

• The use of corticosteroids in pediatric lung disease requires a careful balance between therapeutic benefits and potential adverse effects, particularly growth and adrenal suppression.
• While inhaled CS reduce systemic risks, they do not eliminate them, necessitating cautious application.
• Evidence-based guidelines are evolving, highlighting the need for judicious corticosteroid selection and monitoring in pediatric respiratory care.