Inhaled steroids are the most effective controller therapy available for asthma. They are the gold standard to which all other asthma medicines are compared. They have been used extensively around the world for over 20 years. Inhaled steroids are generally well-tolerated and safe at the recommended dosages, even when taken for prolonged periods. However, like all medications there may be side effects. In general, side-effects are more likely to occur at higher doses, though there may be some individual variations.
Follow-up visits to your health care provider to decrease the dose of inhaled steroids that your child is taking (when possible) will minimize the chance of a side-effect. Possible side-effects need to be weighed against the risk of untreated asthma.
Local irritation in the mouth and throat are the most common side-effects. Oral candidiasis (thrush) is more frequent in adults than children, and uncommon at lower dosages. Using a spacer device and rinsing the mouth with water after inhalation can prevent this side-effect.
Studies on growth in children on inhaled steroids have been contradictory. Some studies have shown a growth delay in children treated with moderate to high doses of inhaled steroids. This appears to occur only during the first year of treatment. Long-term studies suggest that this is merely a delay in growth, and final adult height is not changed. This suggests that during a growth spurt children can "catch up." Other studies show no delay in growth during the first year of low to medium dose inhaled steroids. It is also known that poorly controlled asthma itself may also slow growth, as can the oral steroids that may be prescribed for an asthma flare.
With each passing year, we are learning more about how to use inhaled steroids in the care of asthma in children. To date, we have very good reason to believe that appropriate use of inhaled steroids in children does not pose significant risk for growth. In fact, poorly controlled asthma is more likely to suppress growth than the regular use of inhaled steroids for asthma control.
Studies on the effect of inhaled steroids and bone mineral density is even more contradictory. Use of high doses of inhaled steroids, use of oral steroids and being a post-menopausal female pose the highest risk. Exercise and adequate doses of calcium and vitamin D can help decrease the risk of osteoporosis. There are simple, noninvasive tests to monitor bone density in children when indicated.
Oral steroids enter the bloodstream to get to the lungs, so they can cause these and other systemic effects, particularly if used frequently or for long periods of time. Other effects include cataracts, increased blood sugar, lack of blood supply to some bones and suppression of the body's own production of steroids needed during stress. Since inhaled steroids reduce the amount of oral steroids that may be needed for asthma, they may be safer than just using as needed mediation in all but the mildest forms of asthma. If your child is given many courses of oral steroids, careful monitoring for some of these side effects may be necessary.
Remember, even children with mild asthma may be hospitalized. And children with any level of asthma severity can still be at risk for death from asthma. The risk of both inhaled and oral steroids must be weighed against the risk of the asthma itself. Careful evaluation and follow-up with your asthma caregiver will help keep your child safe.
Reviewed by: Asthma Section
Date: March 2003