In Children: Corticosteroids for Asthma

Daily inhaled corticosteroids are a key part of the treatment for children with mild, moderate, or severe persistent asthma, the National Asthma Education and Prevention Program says.

A fourth class of asthma, called mild intermittent asthma, in which symptoms occur no more than two days a week or no more than two nights a month, does not require daily inhaled steroids. This is the mildest form of asthma.

Asthma affects more than 6 million U.S. children, making it our most common chronic childhood disease. And the rate of asthma in children has more than doubled in the past two decades. Untreated asthma can lead to missing school and inability to participate in play, sports, and other activities, as well as ER visits and worse.

Untreated, this ailment marked by wheezing and breathlessness can cause trips to the emergency room and worse. People with untreated or inadequately treated asthma may lose a small fraction of lung function each year. Medications can help give a child with asthma a normal life.

What are corticosteroids?

Corticosteroids are medications similar to the hormones produced by the adrenal glands. The inhaled form of these drugs reduces inflammation and swelling in the airways, thus decreasing or preventing acute attacks when used regularly. These medications also may reduce the amount of mucus produced. One thing corticosteroids cannot do: They are not for quick relief of asthma symptoms. Bronchodilators are used for this.

Corticosteroids also may be taken orally, in pill or liquid form, to improve breathing. These oral forms have more side effects, however, than the inhaled forms of corticosteroids. Side effects for long-term use include increased blood pressure, water retention or loss, loss of bone mineral, reduced connective tissue strength, decreased resistance to infection, decreased muscle mass, increased appetite, and cataracts.

What are the risks?

Inhaled corticosteroids may have side effects:

• Thrush. The most common side effect, thrush is a yeast infection of the mouth or throat that causes a white film on the tongue. Using a spacer and rinsing out the mouth after each use can help prevent it.

• Hoarseness

• Slowed physical growth. Some research suggests that inhaled corticosteroids can slow growth, but this is only temporary. These children do end up with normal expected heights as adults.