Risk-Benefit of Asthma Therapy in Children: Topical Corticosteroids

Abstract

Inhaled corticosteroids (ICS) are now considered the most effective asthma therapy, and are first-line therapy for control of asthma in both children and adults [1– 4] . In the past, ICS were mainly used in children with severe persistent asthma. Nowadays, they are also recommended for the treatment of mild to moderate persistent asthma, and in most countries, ICS have become first-line treatment, even for very young children [5] . However, ICS still fail to enjoy a favorable reputation in terms of safety and tolerability [6] . Many patients (and parents) have a “steroid phobia” that is based on the local and systemic adverse events from high-dose ICS or oral corticosteroids, leading to poor compliance [7– 9] . A number of ICS have been developed and made available to treat asthma over the last 30 years. They include beclomethasone dipropionate (BDP), budesonide (BUD), fluticasone propionate (FP), triamcinolone acetonide (TA), flunisolide (FLUN), mometasone furoate (MF), and ciclesonide (CIC) [10] . Each has unique physiochemical properties that confer distinct pharmacologic characteristics regarding potency, efficacy, safety, tolerability, lung deposition, receptor binding, lipophilicity, and esterification (Table 1 ). In children, the best studied ICS to date are BPD and BUD [11] . Therefore, many of the data and references mentioned in this chapter will be from studies on BPD and BUD. The newest ICS is ciclesonide (CIC), of which many studies in asthmatic children were published [12] recently. A recent study by Pedersen et al. concluded that ciclesonide’s safety and efficacy profile in asthmatic children is similar to that of fluticasone propionate [13] .