Inhalation of Corticosteroids and Asthma Management
Abstract
The use of inhaled corticosteroids has emerged to be the most effective measure in the preventive treatment of asthma. Studies have successfully shown than the practice is characterized with various substantial health benefits. Even though this is true, few studies done reveal that its use has both benefits and the risks. In essence, clear knowledge of the efficiency of this practice has not been established. Its benefits and effects are evaluated with regard to the growth in human beings. This asserts the need of engaging in comprehensive inquiry to develop knowledge about this potentially beneficial practice. The purpose of this current study was to ascertain how inhaled corticosteroids suppress normal growth in preadolescents with asthma. This was done in comparison with treatment without corticosteroids. The paper attempts to establish any constructive effect of inhaling corticosteroids in the management of asthma.
Introduction
An overview of the use of inhaled corticosteroids is also presented. The step by step instructions on how to administer the drug was well conducted. With reference to the good procedures done, several findings were also realized. A summary of these include the following; the use of low dosage of steroids has side effects of impaired growth and adrenal suppression.3,4 It has much more benefits which include, reduces symptoms in asthmatic children, their quality of life is improved, lowers airway inflammation, lung functions and bronchial responsiveness are greatly enhanced.4
Inhaled corticosteroids still remain to be the most effective and reliable anti-inflammatory drugs used to treat persistent asthma.3 No other equally effective drug has been available since their introduction in the early 1970s.3 The main purpose of this work was to describe and discuss a research design known as a narrative review. Its focus is on the preadolescents with asthma. The main intention is to discuss on inhaled corticosteroids. The entire paper focuses on giving a narrative review based on the above. Corticosteroids have the ability to reduce asthma mortality and morbidity.3 The use of this drug helps in asthma therapy. This achieves asthma control in children by optimizing lung function.3 It also reduces the day and night symptoms. In a broader way, it lowers asthma attacks.3,4
Several methods are used for this study. These methods have been able to provide the basic information needed for this research. They include searches for key words, for example; Duchene muscular dystrophy (2013), Asthma and Allergy clinics (2007), Inhaled corticosteroids (2010) and many more.
Discussion
Inhaled corticosteroids in asthmatic preadolescents and effects on growth
Corticosteroids have proved to be efficient in the management of asthma. This is because of they are capable of interacting with many routes involved in the inflammatory reactions.6 The use of this particular drug is associated with side effects.6 These at times causes some reluctance among patients and physicians. This is experienced especially where higher doses are applied for longer period.6,4 Before getting to the side of effects of steroids on growth, an outline of factors influencing its bioavailability is given. These factors form the basis of pharmacokinetic and pharmacodynamics attributes of corticosteroids. They include, lipid conjugation, bioavailability, protein binding and the clearance from the systematic circulation.6 The size of the inhaled molecule is the primary aspect that determines the proportion of steroid package in the lower airways. A reduced amount of oral bioavailability enhances a relatively low side effects.6
The three distinct stages of growth must be considered when analyzing the effects of corticosteroids on children. These stages are; the growth period in the first 2-3 years.4,7 This stage is a rapid and a decelerating one. It is under control by the factors responsible for growth of fetus for example, nutrition. The second stage is the childhood growth that mainly happens between 3-11 years of age. It is basically determined by the growth hormones in the endocrine system. The third stage is the pubertal growth. This one is dependent on a combination of sex corticosteroids and the growth hormones4,7. The factors that define development vary depending on the described three stages. It is evident that the retarding effect of growth of an inhaled steroid is more marked in pre-pubertal stage.7
The studies that evaluate the effects of corticosteroids on growth can be divided into four.4 These are; the growth marker studies. It measures the induced changes brought about by corticosteroid. Secondly, the short term studies. It evaluates the growth within periods of 3 months or less. Third is the intermediate-term study. This does not give final adult height.4 The fourth one is long-term studies. It helps in getting growth rate for many years. It is inclusive of the final adult height.
Normal growth of a human being is irregular in the short-term but nonlinear in the long-term.7 It is, therefore, not that easy to ascertain the influence of inhaled corticosteroids. Effects of steroids on development can be evaluated through several means as described below. First, using a Valk knemometer to monitor the linear lower-leg growth rate.2,6 This deice has the ability to detect the changes in the growth rates of the lower-leg.6 This gives short-term effects of steroids. The long-effects are detected by use of stadiometry. It measures statural height.6 This can be influenced by factors like pubertal changes, variance in asthma therapy and systematic use of steroids.6 The growth suppression by steroids is a transient one. The children treated with the corticosteroids have the ability to attain a final adult height. This occurs within the normal range.6 few studies conducted indicate that high doses of steroids may have an effect on growth. Higher doses increase the speed of growth in children.
Long-treatment of asthma by use of corticosteroids leads to stunted growth.1 It, therefore, implies that it suppresses growth. A study of a 19- year old boy who is ambulant Duchenne patient indicates this. The patient is put under long-term treatment of corticosteroids. He had a reduced growth rate just after the first year of corticosteroid treatment.1,9 He had low heights and delayed puberty.1,8 This clearly indicates that prolonged corticosteroid utilization in children results to growth failure. It brings about short stature in children.
The use of corticosteroids also poses adverse effects on children. This is evident in the pre-school going children.3,7 These local adverse effects include oral candidiasis and hoarseness. They put the children in a state of discomfort. This can be lowered by reducing the bioavailability of the steroids.3 Drug delivery to the lungs can also be improved by using better inhalation device.3
Another major systematic effect that is really adverse is the suppression of hypothalamus. The axis responsiveness of hypothalamic-pituitary adrenal is suppressed.3 This is also attributed to the administration of high doses of steroids over a long period of time. The growth suppression by corticosteroids also occur as a result of using low to medium doses.3 The low to moderate dosages of steroids are safe for growth as compared to high doses.
The relationship of corticosteroids with bone metabolism also initiates another effect to growth.3 This effects on children with asthma are not well defined. However, the effects are dose-related. Use of high dosage of steroids enhances adrenal suppression and growth retardation.4 there exists a varying degree of adrenal suppression with reference to different in the steroids being inhaled. The adrenal function of children treated with steroids should be checked. Inhaled steroids also bring about growth impairment. Oral steroids bring about a weak impairment to the body.4
Another case study is in the use of low-dose inhaled beclomethasone. This enhances growth impairment and adrenal suppression in children.5 Uninterrupted use for a long time also causes reduced growth rate. It establishes adverse effects on linear growth as compared to adrenal suppression. This phenomenon is attributed to by many factors. They include, the age, device of delivery, compliance, the size of the particle, severity of asthma and the sensitivity of the individual.5,10 the deposition of inhaled drugs in the lungs is increased with age, decreasing severity of asthma and good compliance. The lowest effective dose may reduce as the child gets older.5
Although corticosteroids have some negative adverse effects on growth as discussed above, they are also of importance.4 they improve the quality of life when administered correctly. They lower symptoms and improve lung function. They also decrease the number of patients. Enhances bronchial responsiveness and exercise-induced asthma.4 Its use reduces the occurrence of acute asthma.6
Conclusion
Asthma as a chronic disease poses several adverse effects to the patient. There is need for its proper control and treatment. Corticosteroids have become the most effective drug of asthma treatment currently. Its effects on growth can be reduced by use of minimum recommendable dosage and appropriate choice of the inhalation device. Low dosage can be used in the preadolescents with asthma. This will not promote any risk of significant growth suppression. Inhaled corticosteroids can suppress normal growth to some minimal extent as compared to treatment without the steroids.
References
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