Running head: CORTICOSTEROIDS 1
Asthma: Corticosteroids use in Children and Side Effects
The key treatments recommended for asthma anti-inflammatory drugs and steroids, including corticosteroids. The drug in question plays a central role in not only controlling the disease but also preventing any other asthma attacks. In essence, they reduce the production of mucus in the airways, inflammation, as well as swelling. When used in asthmatic children, however, recent studies have shown that corticosteroids tend to have a variety of side effects, such as coughing and slowed growth.
In their quantitative study to investigate the various local side effects associated with an inhaled corticosteroid in minors, Waibel and Smith (2002) hypothesized that inhaled corticosteroids (ICS)-related local adverse effects are relatively common in minors, children six years and below. They sampled 639 children who have asthma. The children in question were divided into two groups, and they received daily beclomethasone or budesonide. In the cohort study, the researchers prospectively enrolled patients in addition to performing and completing the clinical examination and a questionnaire survey, respectively — the reason for these activities revolved around the identification of symptoms.
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The study results indicated that at least one local side featured in approximately 61.5% of the children. At the same time, cough during inhalation, thirsty feeling, oral candidiasis, dysphonia, and perioral dermatitis occurred in 39.7%, 21.9%, 10%, 14%, and 2.9% of the children ( Fuhlbrigge, and Kelly ) . The results of this study support previous findings, which established that despite the role played by statistically significant variables, such as higher or lower steroid dose, perioral dermatitis and cough tend to remain prevalent in children under the age of six years, with hoarseness serving as a common side effect among older children. At the same time, other researchers have found that incidences that involve oral candidiasis among children under corticosteroid are unchanged, irrespective of mouth-rising or the use of an inhaler device.
Despite the vital role played by the study in substantiating previous findings regarding corticosteroid in children, it is characterized by recall bias, which featured a great deal during collection. Another shortcoming of the study constitutes the far-reaching negative effects of each of the identified confounding variables. At the same time, the study has failed to show the existence of the much-needed association between oral candidiasis incidences, mouth-washing, an inhaler device. However, the criteria used for candidiasis proved to be one of the frank thrushes, a strong achievement by the study.
Apart from Waibel and Smith (2002), Fuhlbrigge and Kelly (2014) undertook a recent study to examine how corticosteroid affects not only bone mineral density but also growth. The researchers hypothesized that continued administration of systematic corticosteroids in children causes decreased and reduced bone mineral density and growth. The hypothesis is in line with previous studies, such as that conducted by Dahl (2006), which established that long-term use of ICS plays a pivotal role in causing systematic side effects, which impair growth in children, cataracts, low bone mineral density, as well as skin bruising and thinning.
Using the infamous qualitative method, the researchers sample previous studies about the very side effects of the drug, and systematically analyzed them. According to their findings, active corticosteroids, which possess minimum systematic activity, tend to register fewer side effects when compared to systematic corticosteroids. Undoubtedly, this means that corticosteroids with fewer adverse effects remain highly recommended for allergic rhinitis or asthma when given in the correct doses.
Despite this milestone achievement, the study revealed that individual children, who received beclometosone dipropionate, as well as budesonide, recorded decreased linear growth. Moreover, long-term administration of inhaled corticosteroid therapy resulted in high deficits, which persisted into adulthood. The effects of the drug tend to rely on dosage and duration. Therefore, long-term therapy involving corticosteroid can only be safer when the physician given according to the recommended doses and age of children, as well as the use of the right equipment or inhaler.
Questions for Research
Conclusively, it is evident that findings obtained from the reviewed literature have supported conclusions by previous studies that, ICS cause a broad range of local side effects, as well as systematic adverse effects. Most importantly, the study has presented future researchers with the best possible opportunity to ask how the recognition of each of the local side effects of ICS can improve the medication process. At the same time, they should determine whether the administration of the lowest possible systematic corticosteroids doses can reduce the identified side effects.
References
Dahl, R. (2006). Systematic side effects of inhaled corticosteroids in patients with asthma. Respiratory Medicine, 100 (8): 1307-1317.
Fuhlbrigge, A., & Kelly, W. (2014). Inhaled corticosteroids in children: Effects on bone mineral density and growth. The Lancet Respiratory Medicine, 2 (6): 487-496.
Waibel, K., & Smith, L. (2002). Local side-effects of inhaled corticosteroids in asthmatic children. Influence of drug, dose, age, and device. Pediatrics, 110 (2): 462.
