The role of inhaled corticosteroids in children with asthma

Inhaled corticosteroids offer a wide range of anti-inflammatory activity an d have consistently proved to be the most effective medication for the cont rol of childhood asthma. The high efficacy of inhaled corticosteroids has l ed to their use in milder disease and younger children in the hope that per manent changes in lung function and airway remodelling may be prevented. Ho wever, evidence has emerged over the past six years that the first of the i nhaled corticosteroids to become available, beclomethasone dipropionate, ma y cause growth deceleration at a dose of 400 mu g per day. This is especial ly apparent in children with mild symptoms. The newest of the inhaled corti costeroids to be developed, fluticasone propionate, is equipotent to older compounds at half the dose and in low doses is superior in efficacy to sodi um cromoglycate. Two recent studies have shown that fluticasone propionate 100-200 mu g per day does not cause growth suppression in children with mil d asthma. The long term outcome for children who wheeze in early life is di fficult to predict. For this reason the use of inhaled corticosteroids in v ery young children is best reserved for those with severe symptoms or a str ong family history of asthma, and evidence, from measurement of inflammator y markers, of airway inflammation.