Corticosteroids in respiratory diseases: certainties and doubts 60 years later (First part)

Key words: Corticosteroids, Anti-inflammatory drugs, Meccanism of action, Inhaled route, Adverse effects, Respiratory diseases

Corticosteroids are anti-inflammatory drugs which are used in many pulmonary conditions, either systemically or by inhalation. Corticosteroids have a proven beneficial role in asthma, croup, allergic bronchopulmonary aspergillosis and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis and bronchopulmonary dysplasia, their use is controversial and is not recommended routinely. In other conditions, such as tuberculosis, interstitial lung disease, acute lung aspiration and acute respiratory distress syndrome, corticosteroids are often used empirically despite the lack of clear evidence in their favour. There is obvious concern about adverse effects, especially growth and adrenal suppression, induced by systemic corticosteroids in children. These effects have been reduced, but not eliminated with the use of the inhaled route. Physicians should always weigh the benefits against the potential detrimental effects of corticosteroids and the available protocols should be strictly followed in clinical practice.