Inhaled Corticosteroids in Asthmatic Children: Are They as Safe in Infants and Preschoolers as in Older Children? A Review

Inhaled corticosteroids (ICS) are the cornerstone of asthma management both in adults and in children. There are some adverse effects related to the use of these drugs in all ages. Those adverse effects can be local or systemic. From the paediatric point of view, the main worry relates to the effect on growth and on the integrity of the HPA-axis. At the recommended doses, their effect on the latter is not clinically relevant and the slight modification of cortisol levels which occurs while taking them reflects their presence in blood. Although there is a slowing down on growth velocity, this is reduced to the first months of treatment which are followed by a catch up: there is quite consistent data supporting their lack of significant effect on the final height. Other adverse effects which may appear in relation to ICS treatment in children, including infants, are mild or very sporadic. However, it is important to bear in mind that a small proportion of asthmatic children may have a certain idiosyncrasy which makes them especially sensitive to ICS. Furthermore, a close follow up is warranted when, due to the disease severity, higher than the recommended doses of ICS are administered.