[Primum non nocere: inhaled corticoids]

Several studies have been devoted to the possible deleterious effects of inhaled corticosteroids. These products are effective and have been widely used for longer and longer periods. Tests used to detect systemic effects are now quite sensitive allowing us to identify infraclinical purely biological effects resulting from minimal doses. The real value of these tests in predicting long-term deleterious effects such as adrenal failure, osteoporosis or growth retardation are now recognized. However, it is difficult to incriminate corticosteroids alone in certain cases because "parasite" conditions are often created by systemic corticosteroid therapy and because asthma alone can lead to deleterious extrapulmonary effects which should not be considered to result from treatment alone, emphasizing the need for carefully controlled studies. Despite the description of multiple systemic effects, the clinical consequences of long-term inhaled corticosteroids are not at all in the same range as oral corticosteroids. Nevertheless, there is some debate as to the strict indications for inhaled corticosteroids in adults and in children. The use of minimal effective doses in asthma is a primum non nocere.