No doubt, many kids with persistent asthma will have their lives, education, and sports performance improved by daily inhaled corticosteroids, and these decisions should be always made with a wise and well-read doctor. But with the CAMP trial , the Lancet study, and the BASALT trial suggesting as-needed inhaled steroids may be equivalent to daily use in adults with mild-to-moderate asthma, pediatricians might think twice about continuing a kid with mild asthma -- and a half-decent fastball -- for years on a growth-stunting daily inhaled corticosteroid.
The aim of this article is to bring less well recognised adverse effects of inhaled corticosteroids to the attention of prescribers. Whilst inhaled steroids have a more favourable side effect profile than systemic steroids, they are not free from adverse effects. The dose of inhaled steroids used should be carefully monitored, and kept at the lowest dose necessary to maintain adequate control of the patient’s disease process. Be particularly aware of the cumulative effect of co-prescribing various dose forms of corticosteroids (inhaled, intranasal, oral and topical preparations).
Communicating the effectiveness, safety, and importance of ICS for asthma control and addressing concerns about their long-term use should occur at all levels of health care. It is also important for clinicians and educators to tailor their communications based on consideration of the patient’s health literacy level. As well, it is crucial to develop a heightened awareness of health disparities and cultural barriers that facilitate more effective communication with minority (ethnic or racial) or economically disadvantaged patients regarding the use of asthma medications that may improve asthma outcomes.