Oral corticosteroids and asthma in children: Practical considerations

Abstract

When dealing with allergic disorders, pediatricians may prescribe systemic corticosteroids (CS) to treat several different diseases, such as asthma, allergic rhinitis, allergic conjunctivitis, angioedema, eczema, certain types of food allergy, and anaphylaxis, and to prevent a delayed response. The main effects for which they are used in allergy are their anti-inflammatory effect, their ability to relax smooth muscle cells, and their action on the allergic delayed response. In clinical practice, corticophobia may raise doubts in patients and their families. For such reason, it is essential to well educate children and their caregivers: In a study by Najada et al, the authors showed that an appropriate education in managing asthma in children allowed a significant reduction in acute care visits and hospitalizations. 1 Here, we will focus on the prescription of oral CS in children with asthma and wheezing. | PHARMACOK INE TI C S AND S IDE EFFEC TSCorticosteroids bound to two plasma proteins: a corticosteroid-binding globulin (also called "transcortin") and albumin. Nevertheless, only the unbound free fraction is biologically active. 2 CS metabolism is essentially hepatic, being catalyzed by enzymes of the cytochrome P450 family. The pharmacokinetics of CS does not differ between asthmatic and non-asthmatic patients. 2The main side effects of CS in the pediatric population include growth impairment, pubertal disorders, and hirsutism. In adults, the main side effects include acne, delayed cicatrization, the possible appearance of glaucoma, and posterior cataract, and increase the risk of bone fracture. At any age, the use of CS is associated with an increased risk of diabetes, hypertension, and virus reactivation. 2 There are always concerns about CS prescription and the risk of adrenal dysfunction. In a Brazilian study, the authors showed that even the use of CS for short-term courses is associated with an increased risk of transitory suppression of the

Inflammatory related plasma proteins involved in acute preschool wheeze

“…[41][42][43] Furthermore, OCS is widely used in emergency departments to relieve symptoms of wheeze, but studies have shown conflicting evidence of efficacy. [44][45][46] In our study, peripheral blood eosinophil levels were decreased in PW treated with OCS, demonstrating its antiinflammatory effect. Nevertheless, the difference in the expression of all 10 proteins was significant between PW and HC irrespective of OCS treatment in PW.…”

“…Corticosteroids alter the balance between pro‐ and anti‐inflammatory proteins and suppress airway inflammation and are suggested to have the best effect in treating symptoms of wheeze in atopic individuals and children with severe wheeze 41–43 . Furthermore, OCS is widely used in emergency departments to relieve symptoms of wheeze, but studies have shown conflicting evidence of efficacy 44–46 . In our study, peripheral blood eosinophil levels were decreased in PW treated with OCS, demonstrating its anti‐inflammatory effect.…”

Treatment guided by fractional exhaled nitric oxide in addition to standard care in 6- to 15-year-olds with asthma: the RAACENO RCT

“…However, there is evidence that treatment with OCs, such as prednisolone, carries long-term health risks, such as growth impairment, pubertal disorders, hirsutism, diabetes, hypertension and many more. [86][87][88][89] A limitation of the economic analysis is the lack of health-related quality-of-life data for children experiencing exacerbations. Furthermore, previous evidence has suggested that hospitalisations may result in greater quality-of-life loss in children than in adults.…”