Inhaled corticosteroids in childhood asthma: the story continues |
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Authors: | Wim M C van Aalderen Aline B Sprikkelman |
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Institution: | (1) Department of Paediatric Respiratory Medicine and Allergy, Emma Children’s Hospital AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands |
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Abstract: | Inhaled corticosteroids (ICS) are the most effective anti-inflammatory drugs for the treatment of persistent asthma in children.
Treatment with ICS decreases asthma mortality and morbidity, reduces symptoms, improves lung function, reduces bronchial hyperresponsiveness
and reduces the number of exacerbations. The efficacy of ICS in preschool wheezing is controversial. A recent task force from
the European Respiratory Society on preschool wheeze defined two different phenotypes: episodic viral wheeze, wheeze that
occurs only during respiratory viral infections, and multiple-trigger wheeze, where wheeze also occurs in between viral episodes.
Treatment with ICS appears to be more efficacious in the latter phenotype. Small particle ICS may offer a potential benefit
in preschool children because of the favourable spray characteristics. However, the efficacy of small particle ICS in preschool
children has not yet been evaluated in prospective clinical trials. The use of ICS in school children with asthma is safe
with regard to systemic side effects on the hypothalamic–pituitary–adrenal axis, growth and bone metabolism, when used in
low to medium doses. Although safety data in wheezing preschoolers is limited, the data are reassuring. Also for this age
group, adverse events tend to be minimal when the ICS is used in appropriate doses. |
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