Inhaled Corticosteroids and Immune Function in Children with Asthma

Effects of ICS on Immune Function

• Low-to-medium dose ICS have no clinically significant effects on hypothalamic-pituitary-adrenal (HPA) axis function in most children, according to the American Academy of Allergy, Asthma, and Immunology 1, 2
• Rare individuals may show increased susceptibility to infections even at conventional doses of ICS, as noted by the American Academy of Pediatrics 1

Risk-Benefit Analysis for Continuing ICS

• ICS remain the preferred first-line therapy for persistent asthma in children of all ages, with strong evidence for improved outcomes including reduced exacerbations and hospitalizations, as recommended by the National Asthma Education and Prevention Program 3
• For children 5 years and older with mild persistent asthma, low-dose ICS are the preferred therapy, according to the Global Initiative for Asthma 3

Practical Management Approach

• Consider mouth rinsing after ICS administration to reduce local and systemic effects, as suggested by the American College of Allergy, Asthma, and Immunology 5

When to Heighten Concern

• Children receiving high-dose ICS have dose-related increased risk of systemic effects, as noted by the American Thoracic Society 1