Inhaled corticosteroids for asthma prophylaxis

Prophylactic use of corticosteroids for adult and childhood asthma is now widely prescribed in concentrated aerosol preparations, which has reduced the use of oral corticosteroids. However, although generally well tolerated , inhaled corticosteroids can lead to thrush , which is known to occur in 1 % of children and 5-13% of adults in a dose-related manner. Dysphonia has also been associated with inhaled cort icosteroids , though this may be prevented by reducing the corticosteroid dose. Three adults and 1 child who received beclomethasone for 2-12 years have developed posterior subcapsular cataracts attributed to this inhaled corticosteroid .

Adrenal gland suppression by beciomethasone has been shown to occur at dosages of 1500 and 400 J.i.g/day for adults and children, respectively , which is of concern because of possible child growth retardation . In a study which compared asthmatic children who received beclomethasone (n = 81) with asthmatic children on other medication (249), growth retardation was indicated. However, the beclomethasone recipients were older and may have had more severe disease (asthma may lead to a reduced growth rate) . Predicted heights have not , so far, been suggested to be affected ,

Adults receiving beclomethasone 500 J.i.g/bid have been shown to have decreased insulin sensitivity with a rise in total and high density lipoprotein cholesterol concentrations . This may indicate a possible risk of cardiovascular disease, Osteoporosis has also been suggested as a possible adverse effect because of decreased calcium levels.

Inhaled corticosteroid administration requires careful management with dosage titration , especially in children , However, inhaled cort icosteroids ' ... remain a major therapeutic advance in management with few serious side effects compared with long term daily oral corticosteroids '. Stead RJ Cooke J Adverse effects of In hated corticosterOids British Medlcat Journal 298 403-404. 18 Feb 1989 .62>