INHALED CORTICOSTEROIDS IN CHILDREN - IS THERE A SAFE DOSAGE

Inhaled corticosteroids are effective for the treatment of asthma. Bec ause of the appreciation of the importance of airway inflammation in t he pathogenesis of the disease, these drugs are being used more freque ntly not only in severe but also in moderate asthma. Treatment rarely has to be stopped because of topical adverse effects since oropharynge al candidiasis and dysphonia are uncommon in children. However, paedia tricians need to remain alert for the possibility of systemic adverse effects. With sensitive techniques, dose-dependent adrenal suppression has been documented in children treated with inhaled steroids but gen erally this effect has no clinical relevance. Although suppression of short term growth velocity has been reported, long term studies have s hown that when growth impairment occurs in a child with asthma it is m ore likely to reflect poor asthma control than the administration of i nhaled corticosteroids. Calcium supplementation may be necessary in ch ildren with asthma treated with inhaled steroids since this treatment may cause reduction in osteocalcin, a marker of osteoblast activity an d bone formation. Other systemic adverse effects have been reported in case reports. The use of a large spacer device has been shown to redu ce the incidence of both topical and systemic adverse effects from inh aled steroids and their use should be encouraged. In any child with as thma who really needs inhaled steroids, the lowest dose possible shoul d be prescribed; however, the mistake of prescribing doses too low to be therapeutically effective should be avoided.