DIAGNOSIS AND TREATMENT: USE OF STEROIDS IN ASTHMA IN CHILDREN

Abstract

ALTHOUGH cortisone and its derivatives have been widely and increasingly used in the management of allergic conditions during the past fifteen years, no final judgment has been reached as to their place in management of asthma, either in adults or in children. The seriousness of unresolved questions is well exemplified in the discussion by Alexander, Samter, Arbesman, and others as to whether mortality in asthma has fallen or risen since corticosteroid drugs became available. Without taking sides we can acknowledge that because these agents are both effective and hazardous, their use poses a dilemma. The therapeutic effects of steroids have not been easily separated from their undesired side effects, particularly in prolonged use. Table I lists the better-known effects of chronic administration. The likelihood of each effect varies with the drug used, the effects on fluid and electrolyte economy having been particularly well separated in some agents from the anti-inflammatory effects. It has not been possible, however, to attain adequate anti-inflammatory effects without some stimulation of protein catabolic processes or without some evidence of increased susceptibility to infection or to adrenal suppression. The subtle nature of symptoms of infection in patients receiving steroid therapy may lead to disastrous delays in diagnosis, and have given rise to the legendary patient receiving steroid therapy who "walks to his place on the autopsy table." Certain side effects are more or less specific features of certain agents, such as the marked stimulation of appetite, the weight gain, and the euphoria associated with dexamethasone, or the anorexia, depression, and toxic myopathy associated with triamcinolone. Sometimes a distressing side effect may be avoided by change in agent; highly soluble prednisolone phosphate appears, for example, less likely than prednisolone to stimulate peptic ulceration.