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Treatment: What are the side effects of inhaled steroids, and how much of a concern should they be?
Medication for asthma is used to reverse and prevent symptoms and airflow limitation. This includes controllers and relievers. Controllers are taken daily on a long-term basis and are useful in keeping persistent asthma under control. Inhaled glucocorticosteroids (ICSs) can reduce oral corticosteroid requirements in adults and children with persistent asthma and during acute exacerbations. Whilst currently available inhaled glucocorticosteroids are absorbed from the lung, and there is inevitably some systemic absorption, there is little evidence of systemic harm at low doses.11 The reduced systemic activity associated with ICS treatment compared with oral steroid therapy improves the overall safety of asthma therapy.12 Randomised trials suggest ICSs are at present the most efficacious controller. There is some observational study evidence that ICSs have some effect on avoiding airway wall thickening, airway remodelling and subsequent chronic airflow obstruction.13 As well as systemic effects, there is an increasing evidence base suggesting there are problems with local side-effects.14 The size of this problem, its impact on adherence and strategies to overcome it are urgently required.
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