Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia

Abstract

Objective: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma.Sources: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected.Summary of the findings: In vivo and in vitro studies show that the available ICS have different pharmacokinetic and pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate.

Glucocorticoids in the treatment of neonatal meconium aspiration syndrome

“…However, depending on the system of delivery and dose used, <20% of the nebulized GCs is deposited into the lungs and the rest may be absorbed into the circulation from the gastrointestinal system and subsequently cause systemic effects [61]. In addition, inhalation of GCs may worsen the course of bacterial infections after initial improvement and may increase the risk of oropharyngeal candidiasis, dysphonia, cough, throat irritation and other local side effects [3].…”

“…In respirology, GCs (mainly inhalational GCs such as budesonide) are used in asthma and exacerbations of chronic obstructive pulmonary disease [6, 43, 61]. In perinatal period, GCs may be administered antenatally or postnatally.…”

“…Considering high extrapulmonal losses (>80%) of nebulized material [61], other ways of administration, such as slow administration directly into the trachea, should be considered. In our study, budesonide administered via inpulsion effect of HFJV effectively improved the lung functions with minimum losses of the drug and negligible side effects [49, 51].…”