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[Safety and side effects of inhalant steroid therapy in children with bronchial asthma]
1Alpine Kinderklinik, Davos.
Insights
Inhaled corticosteroids effectively control childhood asthma, but potential side effects like growth suppression require careful monitoring. Doses up to 800 micrograms/day are generally safe, though individual reactions necessitate clinical vigilance.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
Context:
- Inhaled corticosteroids (ICS) are the primary treatment for pediatric asthma, managing airway inflammation with advanced formulations.
- Effective asthma control in children relies heavily on topical inhalative corticosteroids.
Purpose:
- To outline the standard treatment for pediatric asthma using inhaled steroids.
- To identify and discuss potential dose-dependent side effects of inhaled corticosteroid therapy in children.
- To emphasize the importance of clinical monitoring for children undergoing inhaled steroid treatment.
Summary:
- Most childhood asthma cases are well-controlled with modern topical inhalative corticosteroids.
- Key concerns include dose-dependent suppression of the hypothalamic-pituitary-adrenocortical axis and growth, influenced by dosage, duration, and growth phase.
- Current evidence suggests topical steroid doses up to approximately 800 micrograms/day are generally safe, but individual sensitivities warrant close clinical observation.
Impact:
- Informs clinical practice regarding safe inhaled corticosteroid dosing and monitoring in pediatric asthma management.
- Highlights the need for vigilant surveillance to detect rare individual adverse reactions to inhaled steroids in children.
- Contributes to optimizing therapeutic strategies for childhood asthma, balancing efficacy with safety.
Abstract:
Therapy of asthma with inhaled steroids in children becomes the main standard for treatment of asthmatic airway inflammation. Thus, in most children asthma is controlled by the new galenic formulations of topical inhalative corticosteroids. Dose-dependent side effects must be known and have to be detected by appropriate testing. In childhood the suppression of the hypothalamic-pituitary-adrenocortical axis and of growth is the main concern of steroid therapy. The latter depends on dose and duration of intake as well as the susceptibility of the growth phase during which the child inhales steroids. Today, doses of topical steroid up to about 800 micrograms/day seem to be safe. However, some cases with individual reactions to low doses of inhaled steroids are known: therefore, close clinical control of children on inhaled steroids is extremely important.