The effectiveness of inhaled corticosteroids (ICSs) in treating various chronic respiratory illnesses, such as allergic rhinitis, asthma, and cystic fibrosis, has increased over the years. Newer devices and formulations of the inhaled drug have reduced local adverse effects, but the improved delivery of the drug to the lungs increases systemic absorption and consequently can present a new set of adverse effects. This review article reviews the range and severity of these effects in children and sites various recommendations for prescribers and health care professionals when giving such inhalants.
The most serious potential adverse effect that can result from inhaled corticosteroids is adrenal insufficiency. Long term use of ICSs in children can lead to bone mineralization, DM1 and DM2, obesity, and this insufficiency, or suppression of the hypothalamic-pituitary-adrenal. The authors reviewed a case study on a 7-year-old female that presented with a new onset seizure due to adrenal insufficiency after using an inhalant regimen to treat her asthma. They concluded that clinical effectiveness of inhalants and systemic absorption have a strong positive correlation that can only be partially explained by the device and formulation modifications of the drug. Conclusions and research were also done on the drugs’ effects on bone mineral density, which were found to be mild, and suppression of linear growth, which were found to be slightly correlated. The article presents that generally, inhaled corticosteroids are safe and effective drugs, but life-threatening endocrine effects can occur even with normal doses. It is suggested that reducing systemic adverse effects could require increasing drug protein binding and rapid clearance time, as well as decreased lipophilicity.
This article brings to light something that most parents of children using inhaled corticosteroids are unaware about. I think that using education in this case is probably the best way to avoid this problem, seeing as inhaled corticosteroids are the most effective treatment in reducing respiratory distress. Pharmacists caring for children that routinely use ICSs could really play a major part in watching for adverse endocrine effects by providing correct dosing schedules and learning about how often patients use their inhalers.
JAMA Pediatr. 2016;170(2):163-170. Link to Article