Asthma is a serious global health problem that starts in childhood.
In most cases, inhaled drug therapy is advised which has to be taken lifelong. Inhaled corticosteroid
therapy is considered to be the most effective and preferred first-line asthma
treatment for long term control in children since it reduces asthma
deaths, number of episodes, severity of exacerbations, and improve quality of
corticosteroids (ICS) are preferred over oral corticosteroids because of their
local effect on the airways.
However, a recent
review study published in The Cochrane Library indicated that growth of
children slowed in the first year of treatment using inhaled corticosteroid
drugs. But, the effects were minimized by using lower doses.
'The evidence we reviewed suggests that children
treated daily with inhaled corticosteroids may grow approximately half a centimetre less during the first
year of treatment
,' said lead author of the review, Linjie Zhang, Federal
University of Rio Grande, Brazil.
this effect is less pronounced in subsequent years, is not cumulative, and
seems minor compared to the known benefits of the drugs for controlling asthma
and ensuring full lung growth,' she added.
Asthma drugs list
The following inhaled
corticosteroid drugs are currently approved by the FDA for the treatment of
asthma in adults and children -
Of these, ciclesonide, fluticasone and mometasone are newer
and are considered to be safer drugs.
Budesonide is the only inhaled
corticosteroid approved for use in children younger than 4 years of age.
No inhaled corticosteroids are approved by the FDA for
children younger than 1 year of age.
Following is the
comprehensive list of FDA-approved asthma drugs
that do not use chlorofluorocarbon (CFC). CFC was used as a
propellant in the inhalers, but is now being replaced due to its damaging
effect on the atmosphere.
Tudorza Pressair (aclidinium bromide)
Proventil HFA, Ventolin HFA, ProAir HFA - (albuterol sulfate)
Combivent Respimat (albuterol sulfate and ipratropium bromide)
Duoneb (albuterol sulfate and ipratropium bromide)
Brovana (arformoterol tartrate)
QVAR (beclomethasone dipropionate)
Pulmicort Turbohaler, Pulmicort Flexhaler (budesonide)
Symbicort (budesonide and formoterol fumarate)
Breo Ellipta (fluticasone furoate and vilanterol trifenatate)
Flovent HFA (fluticasone propionate HFA)
Flovent Diskus (fluticasone propionate)
Foradil Aerolizer (formoterol fumarate)
Perforomist (formoterol fumarate)
Arcapta Neohaler (indacaterol)
Atrovent HFA (ipratropium bromide HFA)
Xopenex (levalbuterol sulfate HFA)
Asmanex Twisthaler (mometasone furoate)
Dulera (mometasone furoate and formoterol fumarate)
Serevent Diskus (salmeterol xinafoate)
ADVAIR Diskus (salmeterol xinafoate/fluticasone propionate)
ADVAIR HFA (salmeterol xinafoate/fluticasone propionate)
Spiriva Handihaler (tiotropium bromide)
Asthma drug side effects
effectiveness, asthma drugs come with their share of side effects, especially
if the drugs are in the form of steroid tablets.
Side effects of
steroid tablets include -
Suppression of the adrenal glands
Tendency towards high blood pressure and diabetes
Mood changes and forgetfulness
corticosteroids, on the other hand, have minimal side effects. This is because
only a miniscule amount of the drug enters the bloodstream. So, they are safe
at low doses.
High doses of inhaled
corticosteroids can cause side effects which include -
Thrush: It is a yeast infection that occurs in the mouth. Rinsing the mouth or
using a spacer with metered dose inhalers (MDI) prevents thrush.
Predisposition to cataracts and glaucoma
Thinning of bones
Bones in children are
sensitive to even small amounts of corticosteroids that can enter the
bloodstream after inhalation. So, long term use of these steroids may slow bone
growth, and children may not reach their potential height. However, as the
review studies point out, the effect is quite small and is less pronounced
after first year of use.
Not giving inhaled
corticosteroids to children for fear of growth
suppression (only half a centimeter in the first year and less in subsequent
years) can have far worse consequences in the form of severe asthma attacks and