Benefits and risks of inhaled glucocorticoids in children with persistent asthma

In children, an inhaled glucocorticoid is currently the medication of choice for the long-term control of persistent asthma. Inhaled glucocorticoids are significantly more effective than nonsteroidal medications on all outcome measures of asthma treatment. They reduce the frequency of symptoms and of acute asthma exacerbations, decrease the need for "rescue" medications, improve airway patency, and reduce airway hyperresponsiveness. These considerable long-term benefits are worth the minimal risks of clinically significant local or systemic adverse effects. An inhaled glucocorticoid should be used in the lowest dose that prevents symptoms and eliminates the need for supplemental courses of ingested glucocorticoids. Pulmonary function and height velocity of children receiving an inhaled glucocorticoid should be monitored at regular intervals.