Inhaled corticosteroids are a highly effective treatment for asthma.  By reducing need for oral corticosteroids, one also reduces need for oral steroids and treatment-related problems from oral steroids.  Such problems include: reduced mineral-bone density, reduced growth velocity in children, and increased skin bruising.  But, as inhaled corticosteroids are absorbed from the lungs and the gastrointestinal tract, there is evidence that these symptoms may also occur among some on inhaled corticosteroids. 

Investigators searched the medical literature to identify articles (published since 1966) characterized by having large study-populations and adequate durations of time to monitor children for effects.  Results of these studies demonstrated that inhaled corticosteroids do cause some systemic effects, including reduced bone mineral density.  However, it is important to understand the low magnitude of this effect.  Daily inhalation of high-dose corticosteroids for a full 14 years may be expected to double the risk of a fracture.  With up to moderate daily doses, target adult height is usually achieved despite short-term reduction in growth velocity.  Nevertheless, the author suggests that more research is needed to look at safe doses and other ways to reduce systemic effects.  

(Mortimer KJ et al, Ann Allerg Asthma Immunol. 2005; 94:15-22.)      -- H.T.