What are the adverse effects of long-term use of high-dose steroids for the treatment of pediatric asthma?

Updated: Jan 08, 2019
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Kenan Haver, MD  more...
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Answer

In children, long-term use of high-dose steroids (systemic or inhaled) may lead to adverse effects, including growth failure. Recent data from the Childhood Asthma Management Program (CAMP) study and results of the long-term use of inhaled steroids (budesonide) suggest that the long-term use of inhaled steroids has no sustained adverse effect on growth in children. [59, 60]

A review by Rodrigo et al looked at 8 studies of omalizumab in children with moderate to severe asthma and elevated IgE levels. [61] Children treated with omalizumab were more significantly able to reduce their use of rescue inhalers and their inhaled and/or oral steroid dose than patients in the placebo group. Although no significant differences in pulmonary function were observed, patients receiving omalizumab had fewer exacerbations than the children receiving placebo. These studies lasted a year or less and did not reveal any significant adverse effects of the omalizumab.

A randomized trial of omalizumab for asthma in inner-city children showed improved asthma control, elimination of seasonal peaks in asthmatic exacerbations, and reduced need for other medications for asthma control. [62]

Another study, by Deschildre et al, indicated that adding omalizumab to maintenance therapy can improve asthma control in children with severe, uncontrolled allergic asthma. In a study of 104 such children, Deschildre and colleagues found that adding omalizumab increased the rate of good asthma control from 0% to 53% and reduced exacerbation and hospitalization rates by 72% and 88.5%, respectively. By 1-year follow-up, FEV1 (forced expiratory volume in 1 second) had improved in the study's patients by 4.9%, and inhaled corticosteroid dose had decreased by 30%. [63, 64]


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