Steroids in asthma: are they safe?

Inhaled steroids have been used for decades to reduce inflammation, swelling, and mucus production in the airways of children with asthma. They are considered first-line therapy for children who have persistent asthma symptoms, yet many parents have concerns about giving such a potent medicine to their children. Are steroids in children safe, and if so, what are the major side effects to look out for?

First, it’s important to understand that inhaled steroids are not the same as anabolic steroids (the kind bodybuilders use to build muscle). The steroids used for the treatment of asthma are anti-inflammatory drugs, not hormones. They work by reducing inflammation in the airways and reducing the symptoms of asthma.

The most common inhaled steroid medications include:

• Advair
• Flovent
• Pulmicort
• Qvar

Side effects of inhaled steroids

One common side effect of long-term use of inhaled steroids is an increased risk of yeast infections, or thrush, in the mouth. It’s important to have your child rinse, gargle, and spit after each dose (if they are old enough to perform this activity). The risk of thrush can also be minimized by using a spacer with the inhaler or asking your child’s doctor to prescribe the lowest dose needed.

The most controversial potential side effect of inhaled steroids is growth suppression, but studies are contradictory. Some studies suggest that children may have delayed growth in the first year they are on inhaled steroids. However, long-term studies suggest this is a temporary delay and most children catch up, meaning their final adult height is not affected. In fact, uncontrolled severe asthma is more likely to cause growth suppression than the medication used to treat it.

Other well-known side effects of steroids, such as elevated blood pressure, decreased bone density, thinning of the skin, and cataracts, are seen with oral or topical steroids, but are not associated with inhaled steroids.

Despite the potential side effects, it is widely believed by pediatricians that inhaled steroids are safe, which is why they are the gold standard for treating persistent asthma symptoms. Talk to your pediatrician to ensure your child is on the lowest dose necessary to keep the symptoms under control, as the likelihood of side effects is greater on moderate to high doses.