INHALED GLUCOCORTICOIDS

Key words: Asthma, Inhaled glucocorticoids

In spite of the progress of scientific knowledge, asthma remains an intractable disease. The target of the therapeutic strategy is therefore the greatest possible improvement of the patient’s quality of life. Inhaled glucocorticoids (IGCS) are at present the best therapeutic tool in chronic asthma. They have a strong local activity with minimal systemic effects. Atopic patients with persistent airflow obstruction should receive IGCS irrespective of age. IGCS should be used as first therapeutic step to reduce bronchial hyperreactivity while other drugs such as sodium cromoglycate should be used only to maintain clinical remission. The choice of the best device to administer IGCS (inhaler, spray, turbohaler, nebulizer) depends on the age and the needs of the child. The daily dose should not exceed 10-15 mg (beclometasone equivalent) and, as a rule, the minimum effective dose should be used. A single cumulative dose at 5 p.m. is as effective as two or three divided doses. Side effects are negligible when these indications are followed. At present, there is not clear evidence for IGCS in the treatment of acute asthma attacks.