Inhaled glucocorticoid therapy in infants at risk for neonatal chronic lung disease

The primary impetus for the study of inhaled glucocorticoid therapy in the treatment and prevention of neonatal chronic lung disease (CLD) was to achi eve effective anti-inflammatory therapy with few adverse effects. Initial r eports of inhaled glucocorticoid therapy in infants with established CLD su ggest modest improvement in neonatal respiratory outcomes. Recent randomize d trials also indicate that inhaled glucocorticoid therapy may provide some benefit, but have not demonstrated a reduction in CLD. Some studies sugges t that the pulmonary response to systemic glucocorticoid may be greater and faster than response to inhaled glucocorticoid therapy. Few adverse effect s have been noted with inhaled glucocorticoid therapy. One limitation of st udies of inhaled glucocorticoid therapy is the uncertainty of the dose deli vered and deposited in peripheral airways and regions of the lungs. Experie nce with and systematic study of inhaled glucocorticoid therapy is still in its early stages. The role of inhaled glucocorticoid therapy in the treatm ent and prevention of CLD is evolving. Advances in delivery devices and new developments of drug formulations should improve aerosol delivery and depo sition in infants. Given the clinical dilemma of systemic glucocorticoid th erapy and potential benefits demonstrated by recent trials of inhaled gluco corticoid therapy, further study of inhaled glucocorticoid therapy for CLD is warranted.