Corticosteroid Use in Pediatric Respiratory Conditions

Diagnostic Considerations

Asthma should never be diagnosed based on breathing difficulty or cough alone, as these symptoms are highly nonspecific, according to the European Respiratory Society 1, 2, 3
The European Respiratory Society strongly recommends against diagnosing asthma without objective evidence, such as spirometry with bronchodilator response, FeNO testing, or documented wheeze 2, 4
Recurrent wheeze is the most important symptom suggesting asthma or reactive airway disease, and should be documented by auscultation or parental report of recurrent episodes 2, 6

The European Respiratory Society recommends against using prednisone for chronic cough without documented wheeze or airway obstruction 5, 4
In children under 5 years, diagnosis relies primarily on clinical assessment, including documented wheeze, pattern of symptoms, and response to bronchodilator treatment, due to the lack of feasibility of spirometry 6
The American Thoracic Society suggests that inhaled corticosteroids via MDI and spacer are preferred over oral steroids for chronic management to minimize systemic side effects 7

Long-term corticosteroid use can cause growth retardation, increased blood pressure, osteoporosis, and adrenal suppression, according to the American Journal of Respiratory and Critical Care Medicine 7
Breathing difficulty has very poor specificity for asthma diagnosis, and should not be used as the sole criterion for initiating corticosteroid treatment 1, 3