Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 179-180 (doi:10.1542/peds.2007-2751)
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COMMENTARY

Safer Inhaled Corticosteroid Therapy for Asthma

Kenneth R. Chapman, MD, MSc, FRCPC, FACP, FCCP

Asthma and Airway Centre, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada

The first 20% of the full text of this article appears below.

When symptoms of childhood asthma are persistent and intrusive, no therapy restores control more reliably than the inhalation of topically effective corticosteroids. Within days, nocturnal symptoms of cough and wheeze become infrequent or disappear. When measured, lung function shows improvement and diurnal fluctuations in airway caliber show a decrease. In the ensuing weeks, daytime episodes of asthma will become less frequent, and laboratory measures of nonspecific bronchial hyperresponsiveness will improve. Underlying these changes is the restoration of normal airway histology. Bronchial biopsies in the patient with uncontrolled asthma show infiltration of the mucosa by eosinophils, disruption of the airway epithelium, and elaboration of tenacious mucous. This inflamed and edematous airway becomes more normal in appearance with several weeks of inhaled corticosteroid therapy such that bronchial biopsies in the steroid-treated patient appear normal or nearly so.1 Understandably, national and international guidelines for the management of pediatric and adult asthma postulate that inhaled corticosteroids are the most reliable foundation of pharmacotherapy in persistent disease.2

Regrettably, the parents of children with asthma and many clinicians who treat children with asthma are often reluctant to consider the use of inhaled corticosteroids.3 Many parental concerns are ill-informed and can be addressed by education. For example, parents may confuse the antiinflammatory corticosteroids for asthma care with the masculinizing steroids often abused by professional athletes or will express . . . [Full Text of this Article]

Address correspondence to Kenneth R. Chapman, MD, MSc, FRCPC, FACP, FCCP, Asthma and Airway Centre, University Health Network, Toronto Western Hospital, Room 7-451 East Wing, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8. E-mail: kchapman@ca.inter.net