Use of steroids in pediatric asthma

Steroids are necessary for treatment of chronic asthma. They are life-saving in many acute exacerbations and enable daily functioning free of wheezing and disability for the chronic asthmatic. The beneficial effect of steroids for asthma is increasingly thought to be due to their anti-inflammatory effect on hyperreactive airways. Attempts have been made to develop synthetic steroids to maximize the anti-inflammatory effect on the target tissue while decreasing adverse effects on other tissues. Inhaled steroids with potent topical and minimal systemic effects have been the most important breakthrough in this regard. Long-term follow-up studies for over ten years of beclomethasone have not shown serious local or systemic side effects. Intravenous or oral steroids are still needed for acute exacerbations, and prednisone may be needed in combination with inhaled steroids for the severe asthmatic. Treatment of this complex, variable disease with any type of steroid should be accompanied by objective measurements of benefit (pulmonary function) and risk (steroid side effects).