In recent years, significant progress has been noted in the treatment of bronchial asthma. This is mainly due to the widespread use of corticosteroids as basic anti-inflammatory drugs. However, the use of hormonal therapy raises questions about the safety of such treatment, especially applied to children. Since children’s hormonal system is not yet formed, it is imperative to consider all possible side effects before prescribing treatment. Depending on the affinity of corticosteroids to the receptor, lipophilicity, half-life, and other factors, specialists single out systemic and local undesirable effects of hormonal therapy. This research focuses on systemic side effects of corticosteroids since these can be the most drastic and significantly impact the patients’ ultimate quality of life. The analysis will be conducted through a scientific literature review as a synthesis of the latest developments allows to show how the strengths of corticosteroids are balanced against possible side effects. The articles chosen for this review shed light on the frequency of negative effects and suggest ways of offsetting possible negative outcomes.
The article “Oral corticosteroids and asthma in children: Practical considerations” is a scientific literature review examining the most frequent side effects of corticosteroid therapy in children. Having synthesized a large number of scientific literature on the topic, the authors single out the most typical side effects characteristic of using corticosteroids in asthma treatment (De Filippo et al., 2020). The authors state that “the main side effects of CS in the pediatric population include growth impairment, pubertal disorders, and hirsutism” and “an increased risk of diabetes, hypertension, and virus reactivation” for children and adults alike (De Filippo et al., 2020, p. 43). Moreover, for children, even short-term use of corticosteroids poses “a risk of adrenal dysfunction” (De Filippo et al., 2020, p. 44). There is a direct correlation between the frequency and the dose of corticosteroids and the frequency and severity of side effects. The authors state that the larger dose is used, the more severe the side effects are and recommend using the minimal effective amount for asthma treatment in children.
The strength of this article is in singling out the most common side effects specific to the children’s population. While many works feature side effects in adults or all-age groups, all-embracing and extensive study of adverse effects in children’s population has not so far been undertaken. De Filippo et al. fill this gap in the knowledge by looking at every piece of credible information available about the adverse effects of corticosteroids in children and make extensive coverage of this issue.
The weakness of the article lies in the fact that no specific corticosteroids were named as conducive to this or that side effect. The analysis is more general, and prescribing corticosteroids for different groups, the doctors may not be aware of what specific side effects they may expect. While there is extensive information on the benefits of different corticosteroids for asthma treatment, there is still very little information about the difference in specific systemic and long-time effects of treatment with different corticosteroids.
The article “Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma” is a study of the negative effects of administering corticosteroids to children with asthma. The framework for this research embraces the actual measurements of such properties as growth, adrenal suppression, bone health, and vitamin D level in two groups of children (Kwda et al., 2019). The first group included 70 children with asthma receiving corticosteroid therapy, and the second group embraced 70 children with the same diagnosis not taking corticosteroids (Kwda et al., 2019). Comparing measurements within two groups, the authors found out that corticosteroids had no clinically significant effect on growth, bone metabolism, and vitamin D levels but were responsible for adrenal suppression.
The strength of this article lies in the fact that the authors clinically tested different hypotheses usually associated with corticosteroid taking and found out which of them are clinically significant and which are not. Thus, it was found that only adrenal suppression is actually influenced by corticosteroid taking, while other properties remain relatively unchanged. However, there is no clinical recommendation as to how this side effect can be offset. The weakness of this article is that only four properties were studied and measured. At the same time, such adverse effects as pubertal disorders, hirsutism, risk of diabetes, and virus reactivation were left out of the picture.
The article “A Review on the safety and efficacy of inhaled corticosteroids in the management of asthma” is a scientific literature review. It looks at how severe asthma develops, medication mechanisms of action, factors influencing the efficacy of corticosteroid therapy, and possible side effects. The authors state that “systemic side effects of ICS depend on […] the dose delivered, a delivery device used, site of delivery, and individual differences in response to the corticosteroid” (Ye et al., 2017, p.9). Among adverse effects in children, Ye et al. name adrenal crisis, growth suppression, bone fractures and osteoporosis, infections, and cataract and glaucoma (2017). The authors aim to review the current recommendations for corticosteroid treatment, seeking to find a way to minimize possible adverse effects.
The article states that the worst possible side effect of continuous corticosteroid use is “adrenal crisis after complete suppression of HPA-axis.” In contrast, bone fractures, growth suppression, and infections were found to be independent of the use of corticosteroids (Ye et al., 2017, p 9). As for cataracts and glaucoma, “the risk of [their] formation with ICS use have shown conflicting results” (Ye et al., 2017, p. 10). Only cataract development was found to be influenced by corticosteroid treatment, while the correlation between corticosteroids and the development of glaucoma was not found statistically relevant.
The strength of this article lies in the fact that it embraces all aspects of corticosteroid therapy for asthma, starting from the mechanisms through which the disease develops and ending with side effects and the ways to minimize them. The authors enumerate the therapy’s adverse effects and let readers see why some of these side effects are corticosteroids-related, and others are not significant. Moreover, they suggest some alternatives to offset possible negative consequences: minimizing the dose and combining corticosteroids with B2-adrenergic receptor agonists, which shows promising results (Ye et al., 2017). The weakness of the article lies in the fact that there are no data on clinical trials and measurements through which the given results could be obtained.
The articles viewed in this work shed light on what possible negative effects the corticosteroid therapy used for children could lead to and state the correlation between the dose of corticosteroids and potential adverse effects. In pediatrics, it has been found that only adrenal suppression and cataract are directly influenced by corticosteroid taking, while other side effects are not affected by hormonal therapy. The best dose for treating children was found to be minimal since prolonged use of high doses may lead to the development of adverse effects. If the use of a minimal dose is not beneficial for the patient, a combination of corticosteroids with a B2-adrenergic receptor agonist should be used instead. Discussing the negative effects of hormonal therapy, the articles pave the way for further research to find a better medication to treat asthma in pediatric practice.
References
De Filippo, M., Clark, E., Fillard, A., Diaferio, L., & Caimmi, D. (2020). Oral corticosteroids and asthma in children: practical considerations. Pediatric Allergy and Immunology, 31, 43-45. Web.
Kwda, A., Gldc, P., Baui, B., Kasr, K., Us, H., Kantha, L., & Ksh, D. S. (2019). Effect of long-term inhaled corticosteroid therapy on adrenal suppression, growth, and bone health in children with asthma. BMC Pediatrics, 19(1), 1-6. Web.
Ye, Q., He, X. O., & D’Urzo, A. (2017). A review on the safety and efficacy of inhaled corticosteroids in the management of asthma. Pulmonary Therapy, 3(1), 1-18. Web.