Professional Documents
Culture Documents
DOI 10.1007/s11325-011-0639-1
REVIEW
Received: 6 April 2011 / Revised: 30 October 2011 / Accepted: 15 December 2011 / Published online: 6 January 2012
# Springer-Verlag 2012
Abstract
Introduction Despite international consensus and clearly
written guidelines urging wider use of corticosteroids or
combinations of inhaled short- and long-acting -agonists
(SABA and LABA) and corticosteroids in persistent asthma,
prescribing patterns and compliance rates fall far short of
recommendations.
Objectives The failure to use steroids more aggressively is
due, in part, to their side effects, even with inhaled forms of
the drug. There is a role for expanded use of sodium cromolyn
in asthma. Its potent anti-inflammatory effects, lack of side
N. C. Netzer
Hermann Buhl Institute for Hypoxia and Sleep Medicine Research,
Paracelsus Medical University,
Salzburg, Austria
N. C. Netzer
Department of Internal Medicine, University Hospital Ulm,
Ulm, Germany
T. Kpper
Institute of Occupational and Social Medicine,
RWTH Aachen University,
Aachen, Germany
H. W. Voss
Clin Research Inc.,
Cologne, Germany
A. H. Eliasson
Pulmonary Division, Department of Medicine, Uniformed
Services University of the Health Sciences,
Bethesda, MD, USA
1028
and the possible impact on developmental growth and maturation. Recent research has demonstrated decreased bone mineral density and decreased standing height with the use of
potent ICS in children with asthma [5]. Diminished growth in
children on ICS has been shown to be as much as a centimeter
over a 12-month period in a dose-dependent fashion [6], and
this side effect may explain the hesitation of pediatricians to
prescribe steroids freely. While some studies do show good
safety data [7, 8], concerns regarding effects of ICS on growth
have led the Food and Drug Administration to convene a joint
meeting to review the data and to release new class labeling
for ICS that notes this potential side effect [9].
Studies on suppression of the hypothalamuspituitary
adrenal (HPA) axis have been reassuring, but such considerations continue to concern physicians when using higher than
recommended doses or newer, more potent forms of inhaled
steroids [10, 11]. When sensitive measures of basal adrenal
activity are used, dose-related suppressive HPA effects can be
detected with specific drugs and application systems [5,
12-14]. Diminished bone mineral density has been demonstrated with even moderate dose ICS in children and adults
[14, 15]. Eye problems are associated with ICS, including
ocular hypertension, open-angle glaucoma, and cataract formation, though toxicity is much less than with oral doses
required to achieve the same benefit [14, 16, 17]. Local side
effects of cough, hoarseness, pharyngeal thrush, and throat
irritation [18] remind clinicians and patients of the potency of
inhaled steroids. Even the perception of harmful side effects is
a strong deterrent to compliance with any regimen. All of
these problems with ICS, both real and perceived, make it
clear that there is a need for other effective asthma therapies.
1029
1030
Conclusion
There is still an important role for SCG in the treatment of
mild to moderate asthma especially in children as initial antiinflammatory treatment due to its lower risk profile compared
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