Viewer Question: What are the possible long and short term side effects from
inhaled corticosteroid drugs taken for asthma? Is it possible to experience
similar side effects on high doses of the inhaled drugs as on the orally
administered drugs (. prednisone )? There are some potent new inhaled drugs,
. Flovent, that are effective in treating asthma but I was wondering if these
drugs are absorbed into the bloodstream.
Doctor's Response: Current maintenance therapy for asthma is directed primarily at airway inflammation. The application of topical inhaled steroids on the air passages is a very effective means of managing the chronic symptoms of asthma. There are a variety of inhaled steroids available by prescription. These steroids all act in a similar fashion to oral steroids but with fewer side effects. As the dose of inhaled steroids increases so does the potential for some of the more serious steroid complications. The fluorinated steroids fluticasone (Flovent) and budesonide (Pulmicort) are the most potent. It is important to use the lowest effective dose that optimizes lung function and minimizes symptoms. Most of the steroid inhalers when prescribed at the usual dose have an immeasurable effect on the body (that is outside of the air passages). Some potential effects include the suppression of the hypothalamus (in the brain) and the adrenals (above the kidneys). These glands are involved in our bodies response to stress. Measurement of their function is a very sensitive way of determining the impact inhaled steroids may have on the body. When the function of these glands is suppressed than the many side effects seen with oral steroids may also occur. The most common side effect of inhaled steroids is oral candidiasis (thrush). This is easily treated and its occurrence minimized by using a spacing device. Exacerbation of glaucoma has also been reported. To summarize, inhaled steroids are an excellent medication for the treatment of asthma. Their safety profile is terrific when used by knowledgeable practitioners. Thank you for your question.
There have been no randomized trials examining the effect of hydrocortisone given after the first week of life or used to treat infants with prolonged ventilator dependence. One retrospective cohort study compared infants who required assisted ventilation and oxygen after the first one to two weeks of age and received hydrocortisone with a group of healthier infants who did not receive hydrocortisone.  Infants treated with hydrocortisone experienced decreasing oxygen requirements and were successfully weaned from assisted ventilation. After seven days of treatment, there were no differences in oxygen requirements between the two groups. On follow-up, there were no differences in head circumference, neurological outcome, psychomotor development or school performance. Magnetic resonance imaging performed at eight years of age on a similar cohort of infants treated with hydrocortisone showed that although, overall, children born preterm had significantly reduced grey matter volumes compared to term children, there were no differences in the intracranial volumes, grey matter volumes or white matter volumes between children who did and did not receive hydrocortisone for treatment of CLD.  There were also no differences in neurocognitive outcomes, assessed using the Wechsler Intelligence Scales for Children.