Adverse effects of inhaled corticosteroids.

Corticosteroids have a significant role in the management of asthma due to their powerful anti-inflammatory actions. However, when given orally, they cause significant and unwanted side-effects. Early attempts to circumvent these side-effects were largely unsuccessful. Recently, new synthetic corticosteroids have been developed that have powerful topical action but weak generalised effects due to rapid systemic metabolism. These new compounds provide adequate control of airways' obstruction in almost all asthmatics. Oral candidiasis may occur but can generally be controlled by adjusting the frequency of dosage and changing delivery systems. In high doses, there is biochemical evidence of adrenal suppression, but the clinical importance of this is not yet clear and there is no evidence of a significant effect on growth in children. High dose inhaled corticosteroids have been shown to affect biochemical indices of bone turnover in the short term. The long term clinical consequences of this are still under evaluation. Inhaled corticosteroids have provided a significant advance in the management of asthma, but physicians need to remain alert for the possibility of systemic side effects when used in high doses for long periods of time.