The role of corticosteroids in the management of childhood asthma

Preventive treatmentInhaled corticosteroids are indicated in children with asthma who have more than mild persistent asthma or are unresponsive to non-steroidal medications after 2-4 weeks. isInitial administration of 400 mug/day of chlorofluorocarbon-beclomethasone dipropionate, or budesonicle, or 200 mug/ day of fluticasone propionate or hydrofluoroalkane-beclomethasone diproplonate, is suggested, with subsequent titration of the dose to achieve ongoing control with the lowest dose possible.In situations where asthma control cannot be achieved with the above doses of inhaled corticosterolds, the addition of a long-acting beta(2)-agonist, theophylline or a leukotriene antagonist should be considered.Specialist referral is recommended in children requiring high doses of inhaled steroids, regular oral steroids or in whom there is concern about possible steroid side effects.Treatment of acute asthmaSystemic corticosteroid therapy is recommended for children with moderate to severe acute asthma or if there is incomplete response to beta(2)-agonists,Initial administration of 1 mg/kg prednisolone (maximum, 50 mg) orally is suggested, and this may be repeated every 12-24 hours, depending on response. While a course of up to three days is generally sufficient, in more severe cases a prolonged course (with tapering) may occasionally be indicated.The need for recurrent systemic corticosteroid therapy for acute episodes is an indication for reassessment of the child's interval therapy.