Safety of oral corticosteroids

Oral corticosteroids may be life-saving for symptoms of acute asthma, and short courses are often useful to relieve even less serious acute exacerbations when the patient has become inadequately responsive to bronchodilators. Adverse effects are rarely if ever associated with short courses of steroids used for this purpose. Long-term use of oral corticosteroids, however, are associated with a variety of well-established toxic effects. The safe and effective use of oral corticosteroids in substantial doses given every other morning for various steroid-responsive diseases has been described in numerous studies since 1963. Among children with chronic asthma, suppression of the hypothalamic-pituitary-adrenal axis by alternate day prednisone in mean doses of 30 mg was found not to exceed that which occurred with inhaled beclomethasone dipropionate at doses averaging 550 micrograms/day. Growth was also similar in the 2 groups of patients. A few patients receiving alternate-day prednisone gained excessive weight, but this was not a clinical problem for most. Alternate-day prednisone is easier to administer, is associated with better compliance, and costs less than the inhaled steroid. Inhaled beclomethasone dipropionate is more bother, causes cough and throat irritation in some patients, and cannot be administered to very young children. Alternate-day prednisone, given as a single dose every other morning, and the new generation of inhaled steroids such as inhaled beclomethasone dipropionate are alternative means of providing safe and effective treatment with long-term corticosteroid therapy.