Kelly H William, Nelson Harold S
Department of Pediatrics, University of New Mexico Children's Hospital, ACC Building 3rd Floor, 2211 Lomas Boulevard NE, Albuquerque, NM 87131-5311, USA.
J Allergy Clin Immunol. 2003 Sep;112(3):469-78; quiz 479.
The purpose of this review is to provide the clinician with an update on the potential adverse effects caused by the inhaled corticosteroids (ICSs). The systemic effects of ICSs are a result of that portion swallowed and absorbed through the gastrointestinal tract and not eliminated by first-pass metabolism and that portion delivered to the lung and absorbed. If administered in high enough doses, any of the ICSs will produce clinically significant systemic activity. This review will explore the risks for clinically significant adverse effects from sustained use of ICSs, as recommended by the current guidelines. The standard method for assessing systemic activity in short-term studies is measurement of hypothalamic-pituitary-adrenal axis function. The ICSs provided in the medium dose range can produce measurable effects on the hypothalamic-pituitary-adrenal axis. However, clinically significant suppression is unlikely to occur except at high doses. The effect on growth in children over 1 to 4 years occurs at low to medium doses, might be dependent on the specific ICS, and is small (1-2 cm). The data are insufficient to determine whether there is an effect on attainment of predicted adult height. The ICSs affect bone mineral density and risk of fractures in a dose-dependent fashion that appears significant at high doses.
本综述的目的是向临床医生提供吸入性糖皮质激素（ICSs）所致潜在不良反应的最新信息。ICSs的全身效应是由经胃肠道吞咽并吸收且未被首过代谢消除的部分以及输送至肺部并被吸收的部分所导致的。如果给予足够高的剂量，任何一种ICSs都会产生具有临床意义的全身活性。本综述将探讨按照当前指南推荐持续使用ICSs产生具有临床意义的不良反应的风险。短期研究中评估全身活性的标准方法是测量下丘脑 - 垂体 - 肾上腺轴功能。中等剂量范围的ICSs可对下丘脑 - 垂体 - 肾上腺轴产生可测量的影响。然而，除非高剂量使用，否则不太可能发生具有临床意义的抑制作用。1至4岁以上儿童使用ICSs对生长的影响在低至中等剂量时即可出现，可能取决于特定的ICS，且影响较小（1 - 2厘米）。现有数据不足以确定其对预测成人身高的达成是否有影响。ICSs以剂量依赖方式影响骨矿物质密度和骨折风险，在高剂量时这种影响似乎较为显著。
