In Children: Corticosteroids for Asthma

Daily inhaled corticosteroids are a key part of the treatment for children with mild, moderate or severe persistent asthma, the National Asthma Education and Prevention Program says.

A fourth class of asthma, called mild intermittent asthma, in which symptoms occur no more than two days a week or no more than two nights a month, does not require daily inhaled steroids. This is the mildest form of asthma.

"The possible side effects of medication are far less important than the known effects of untreated asthma," says William E. Berger, M.D., past president of the American College of Allergy, Asthma and Immunology.

Asthma affects more than 6 million U.S. children, making it our most common chronic childhood disease. And the rate of asthma in children has more than doubled in the past two decades. Untreated asthma can lead to missing school and inability to participate in play, sports, and other activities, as well as ER visits and worse.

"People need to re-look at asthma and understand that it is a chronic disease," Dr. Berger says. Untreated, this ailment marked by wheezing and breathlessness can cause trips to the emergency room and worse. People with untreated or inadequately treated asthma may lose a small fraction of lung function each year. Medications can help give a child with asthma a normal life.

What are corticosteroids?

Corticosteroids are medications similar to the hormones produced by the adrenal glands. The inhaled form of these drugs reduces inflammation and swelling in the airways. These medications also may reduce the amount of mucus produced. One thing corticosteroids cannot do: They are not for quick relief of asthma symptoms. Bronchodilators are used for this.

Corticosteroids also may be taken orally, in pill or liquid form, to improve breathing. These oral forms have more side effects, however, than the inhaled forms of corticosteroids. Side effects for long-term use include increased blood pressure, water retention or loss, loss of bone mineral, reduced connective tissue strength, decreased resistance to infection, decreased muscle mass, and increased appetite.

What are the risks?

Inhaled corticosteroids may have side effects:

  • Thrush is the most common. Thrush is a yeast infection of the mouth or throat that causes a white film on the tongue. Using a spacer and rinsing out the mouth after each use can help prevent thrush.

  • Hoarseness.

  • Slowed physical growth. Some research suggests that inhaled corticosteroids can slow growth. But studies have shown that the medicine does not necessarily cause decreased height by adulthood.

The risks are minor, Dr. Berger says, and the lower the dose, the smaller the risks. "Be more concerned about the disease and its effects," he says.

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