Safety of inhaled corticosteroids.

Corticosteroids effectively suppress asthma but have unwanted systemic side-effects which can be avoided if taken by inhalation. Inhaled corticosteroids are effective and although sensitive tests can occasionally detect some systemic activity with a daily dose of beclomethasone diproprionate of 400--800 micrograms, in clinical practice systemic side-effects are not seen. If this daily dose is raised above 1.5--2.0 mg systemic activity is more easily detected and is more likely to be of clinical significance. Local side-effects include occasional hoarseness and oropharyngeal thrush. There have been no reports of opportunistic pulmonary infections or bronchial epithelial damage following prolonged use. Inhaled corticosteroids are now in widespread us in over 100 countries throughout the world. They have also been employed for nearly a decade and this extensive clinical experience has not revealed significant systemic side-effects. This safety compares favourably with other asthma treatment and suggests that inhaled corticosteroids may be used when bronchodilators are failing to control symptoms and higher doses are thought necessary or being taken. Better asthma control should reduce bronchodilator consumption and the net incidence of side-effects. Inhaled corticosteroids can therefore safely provide effective treatment and steer a path between the risk of intensive bronchodilator treatment and those produced by systemic steroids.