Evidence strongly suggests that early treatment with corticosteroids is important for children with severe asthma to prevent deterioration in lung function.
Side effects of inhaled steroids may include:
- The most common side effects are throat irritation, hoarseness, and dry mouth. These effects can be minimized or prevented by using a spacer device and rinsing the mouth after each treatment.
- Rashes, wheezing, facial swelling (edema), fungal infections (thrush) in the mouth and throat, and bruising are also possible but not common with inhalators.
- Some children experience changes in mood, memory, and behavior. These changes are not permanent.
- Some studies have suggested a higher risk for gum inflammation.
- Oral steroids reduce bone density. Research now reports that inhaled steroids -- both older and newer drugs -- also may affect bone growth and density. However, a number of studies report only a slight effect (about half an inch) on children's growth, which may be only temporary. It is still unknown if these drugs have any significant long-term effect on bone density. Calcium supplements appear to help prevent bone loss due to inhaled steroids.
- It is not yet known whether inhaled steroids affect lung growth in very young children. Steroids administered using nebulizers are of particular concern.
- There is also some concern that the more potent drugs, particularly fluticasone, suppress the adrenal system to a greater degree than other steroid inhalants. This effect, in turn, reduces levels of natural steroids -- notably cortisol, the major stress hormone. (This is a serious side effect of oral steroids.) Sudden changes in consciousness may suggest low blood sugar, which can occur with adrenal insufficiency and was reported in a few children taking high doses of fluticasone. A 2002 study also observed abnormally lower morning levels of cortisol in children taking fluticasone.
Because the newer potent drugs, particularly fluticasone, may produce major side effects similar to oral steroids, it is important to aim for the lowest effective dose possible. Fortunately, some studies suggest that low doses of fluticasone may achieve the same benefits as with high ones, thus reducing risks for serious side effects. Better delivery methods may also allow lower doses. For example, an encouraging 2002 study suggested that administering lower doses of beclomethasone using an Autohaler, which delivers the drug in an extra-fine spray, were as effective as higher doses delivered with an MDI.
Previous Section
