Inhaled steroids in children: friends or foes?

Inhaled corticosteroids are recognized as the most effective anti-inflammatory therapy in asthmatic children. Concerns have been raised about potential systemic effects. Systemic availability of inhaled corticosteroids is influenced by many factors such as potency and the pharmacodynamic properties of the molecule, delivery methods, or patient characteristics. Few studies take into account these parameters. Available studies suggest that systemic effects are absent or negligible for doses up to 500 mug/day of beclomethasone or equivalent. Significant biological modifications are observed for higher doses concerning the hypothalamic-pituitary-adrenal axis and bone metabolism. Clinical relevance of these modifications remains unknown. No definite growth retardation could be demonstrated, even for high doses of inhaled corticosteroids. (C) 2001 Editions scientifiques et medicales Elsevier SAS.