PEDIATRIC allergists, numbering, as they invariably do, among their patients a small core of chronically ill, steroid-dependent asthmatic youngsters, have long shown an interest in inhalational steroid therapy, particularly since the adverse effects of long-term oral steroid usage became known. Their hope was that direct application of corticosteroids to the bronchi and subbronchial airways might result in a marked reduction in steroid requirements for this group of patients and, at the same time, might keep systemic absorption to such minimal levels that adrenocortical suppression would not occur. Ultimate weaning off of steroids might thus be facilitated. When a compact aerosol eventually was devised which contained the highly water-soluble dexamethasone-sodium-21-phosphate in a small-particled, relatively tasteless form, it was promptly put to clinical trial in centers in this country and elsewhere where young and old asthmatic patients were under treatment. The purpose of this paper is to summarize the published results of these trials to date and to add to them our data which particularly point up the role that dexamethasone aerosol occasionally may play in termi¬ nating a long period of steroid dependence.
MethodsMaterials.-The corticosteroid used in the nebulizers under investigation was dexamethasone-21-phosphate in the form of a highly water-soluble disodium salt. Two types of aerosolized prepara¬ tions were studied. One contained the equivalent of 15 mg of dexamethasone suspended in a solution con¬ sisting of 2% alcohol with sorbitantrioleate as a wetting agent and fluorochlorohydrocarbons as propellents (Decadron Respihalers). The second type contained the above active and inactive in¬ gredients plus 18 mg of isoproterenol sulfate (ProDecadron Respihalers). The active chemicals ranged in particle size from 0.5/t to 4µ. Each metered spray of the nebulizer delivered 0.084 mg dexamethasone base (and 0.