Recalcitrant Wheezing and GI Symptoms in a 10-Year-Old Boy
What is the role of treatment with inhaled corticosteroids in the natural history of asthma? Is there any long-term study about the prognosis of asthmatic children who have been treated with inhaled corticosteroids?

Maria Teresa Fonseca, MD

Asthma treatment guidelines in the United States and Europe indicate that inhaled corticosteroids are the single best medication for the control of chronic childhood asthma. In addition to reducing the frequency and severity of chronic asthma symptoms, inhaled corticosteroids also reduce the frequency of acute exacerbations of asthma, including those leading to acute care visits, the need for systemic corticosteroids, and asthma hospitalizations.

Several large controlled long-term studies have demonstrated these benefits, and have also evaluated the safety of this class of medications in children. The safety record is excellent, although a small reduction in growth velocity (1-1.5 cm/yr in the first year) has been noted in many studies that have used doses in excess of 200 micrograms of fluticasone (or bioequivalent amounts of other corticosteroids). The effect on growth is mainly noted in the first 6-12 months of use, and appears to be temporary. The use of inhaled corticosteroids does not appear to affect the eventual attained height, and so it is likely that catch-up growth does occur.