Inhaled Corticosteroids in Childhood Asthma

Salvatoni, Alessandro; Piantanida, Elena; Nosetti, Luana; Nespoli, Luigi

doi:10.2165/00128072-200305060-00001

Cited by 19 publications

(3 citation statements)

References 47 publications

(15 reference statements)

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“…It is well‐established that long‐term oral and/or inhaled corticosteroid use may affect growth in children 55–57 . The longer and higher doses have more ability to impact growth and bone turnover 58,59 . Therefore, in a chronic condition such as asthma, which often requires daily inhaled corticosteroids, other topical corticosteroids treatments to treat comorbidities (allergic rhinitis, atopic dermatitis) and potentially frequent systemic corticosteroids bursts, there is strong rationale in frequent growth monitoring, particularly for children with less frequent monitoring intervals.…”

Section: Recommendation Statementsmentioning

confidence: 99%

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

Papadopoulos,

Custovic,

Deschildre

et al. 2024

Pediatric Allergy Immunology

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Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well‐being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side‐effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even “real‐time,” monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision‐making and care pathway design. image

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Section: Recommendation Statementsmentioning

confidence: 99%

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

Papadopoulos,

Custovic,

Deschildre

et al. 2024

Pediatric Allergy Immunology

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“…So, there is a need of trials that investigate whether adult height is reduced by ICS in asthmatics (93). The long-term use of ICS at high doses may have effects on hypothalamic-pituitary-adrenal axis, resulting in reduced adrenal cortisol production (94). However, many studies show a wide variability on the partial suppression of adrenal cortisol, depending on the individual susceptibility, the severity of asthma, the type of inhaled corticosteroid and the inhalation device used.…”

Section: Limitation Of Icsmentioning

confidence: 99%

Preschool Wheezing: Trajectories and Long-Term Treatment

2020

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Wheezing is very common in infancy affecting one in three children during the first 3 years of life. Several wheeze phenotypes have been identified and most rely on temporal pattern of symptoms. Assessing the risk of asthma development is difficult. Factors predisposing to onset and persistence of wheezing such as breastfeeding, atopy, indoor allergen exposure, environmental tobacco smoke and viral infections are analyzed. Inhaled corticosteroids are recommended as first choice of controller treatment in all preschool children irrespective of phenotype, but they are particularly beneficial in terms of fewer exacerbations in atopic children. Other therapeutic options include the addition of montelukast or the intermittent use of inhaled corticosteroids. Overuse of inhaled steroids must be avoided. Therefore, adherence to treatment and correct administration of the medications need to be checked at every visit.

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“…Many reviews on the benefits and risks of inhaled corticosteroids (ICS) have been published. Whilst the effectiveness of these agents cannot be disputed (1, 2), the evidence for hypothalamic‐pituitary‐adrenal axis (HPA) suppression was found to be conflicting (3–6). This is not surprising, as reviewers did not differentiate between studies using basal and those using gold standard adrenal function tests.…”

mentioning

confidence: 99%

Hypothalamic‐pituitary‐adrenal axis suppression in asthmatic children on inhaled corticosteroids (Part 2) – the risk as determined by gold standard adrenal function tests: A systematic review

Zöllner

2007

Pediatric Allergy Immunology

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The evidence for hypothalamic-pituitary-adrenal axis (HPA) suppression by inhaled corticosteroids (ICS) was found to be conflicting. Reviewers have not distinguished between gold standard and basal adrenal function tests. The utility of the latter is limited by physiological and pathological variability as well as by methodological concerns. The risk of HPA suppression in asthmatic children and adolescents treated with ICS, as determined by gold standard adrenal function tests, needs to be established. A systematic review of the literature from January 1973 to July 2005 was performed. The Medline and Cochrane databases were searched, the reference lists of retrieved articles were inspected and pharmaceutical companies were approached. Randomized-controlled trials, cohort and case-control studies designed to detect HPA suppression caused by ICS, diagnosed by the insulin tolerance test (ITT) or the metyrapone test, performed on asthmatics of all ages not on oral steroids, were included and assessed for methodological quality. Of the 22 identified studies only four met the criteria for inclusion. All of these were published before 1988 and only one was methodologically sound. The cohort study showed that the baseline risk for HPA suppression is 0% while the absolute risk is 100% in asthmatic children treated with a beclomethasone dipropionate metered dose inhaler at a dose of 250-600 mug/m(2)/day for 6-42 months. As suggested by other observations these results could be generalized to other ICS. They may be of clinical significance especially if children are subjected to stress. Further research is needed to establish the cumulative dose for all ICS at which HPA suppression will be precipitated. Guidelines for future trials are suggested.

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Inhaled Corticosteroids in Childhood Asthma

Cited by 19 publications

References 47 publications

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO

Preschool Wheezing: Trajectories and Long-Term Treatment

Hypothalamic‐pituitary‐adrenal axis suppression in asthmatic children on inhaled corticosteroids (Part 2) – the risk as determined by gold standard adrenal function tests: A systematic review

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