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PULMONOLOGY
for maintenance treatment of
asthma.
The inhaled corticosteroid
dose should be adjusted
according to the level of control
attained. Once control of
asthma is achieved, the dose of
medication should be carefully
titrated to the minimum dose
required to maintain control,
thus reducing the potential for
adverse effects.
Nebulised corticosteroids
are expensive, require high-
pressure nebulisers for
optimal delivery, and are not
recommended for routine use
in chronic asthma.
Side effects
Most studies evaluating the
systemic effects of ICS suggest
that clinically effective doses of
ICS are safe and the potential
risks are well balanced by
the clinical benefits. However,
studies using higher doses
have been associated with
detectable systemic effects
on both growth and the
hypothalamo-pituitary (HPA)
axis. Although there are fewer
studies in children younger
than five years, the available
data are similar to those from
older children. Generally, low
doses of ICS have not been
associated with any clinically
important adverse systemic
effects in clinical trials, and
long-term use is considered
safe. Local side effects, such
as hoarseness and candidiasis,
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can occur, but are rare when a
spacer is used.
Efficacy in children
Most children are controlled on
low daily doses of ICS (100-200
µg budesonide or equivalent ).
Some children require higher
doses (400 µg/day) for control
and for protection against
exercise- induced symptoms.
Clinical improvement
occurs rapidly within 1-2
weeks, although maximum
improvement may occur only
after many weeks. Symptoms
may recur after stopping ICS,
with control deteriorating
within weeks.
Several studies of ICS in
young children under the age
of five years with asthma
have shown similar clinical
effects