Inhaled corticosteroids (ICS) are common medications, used in respiratory medicine for controlling conditions such as asthma and other obstructive airway diseases. The systemic effects of oral corticosteroids are well known and established; inhaled steroids have been known to cause relatively minor and localized adverse effects such as oral candidiasis. However, less attention has been paid to their systemic effects. Although currently there is a paucity of prospective studies demonstrating the systemic effects of inhaled corticosteroids, there are numerous retrospective studies adding evidence to this link. Inhaled corticosteroids can affect the hypothalamo-pituitary-adrenal axis, bone density and growth, eyes, skin and immunity including an increased risk of pneumonia. Clinicians are recommended to aim for the lowest possible dose to avoid these systemic side effects. Fluticasone is more likely to cause systemic effects compared to budesonide. Newer ICS molecules such as ciclesonide may be more beneficial in reducing such systemic complications on prolonged use. This paper provides an updated overview of the common systemic effects encountered with ICS treatment.

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Background: Infantile tremor syndrome (ITS) is a condition reported from many areas of Indian subcontinent due to lack of proper nutrition, improper weaning or delayed introduction of complementary feeding. There is no proven macro or micro nutrient deficiency responsible for it but relation with vitamin B12 deficiency has been identified in some studies. The aim of this study was to study the clinical profile of patients with ITS.Methods: It is a prospective observational study including total 30 patients, from 6 months to 3-year age group, admitted to pediatric wards and nutritional rehabilitation centre, civil hospital, Ahmedabad, from June 2018 to December 2019.Results: Out of 30 patients studied, 69% had pre-ITS and rest had ITS, 61.5% were males and 38.4% were females, 69.2% had severe acute malnutrition, 84.6% had severe anemia and 23% of them presented with CCF, 15.4% patients had microcephaly and 23% had hypotonia. 23% had motor and speech delay. 61.5% belonged to lower socio-economic group. There was delayed introduction of complementary feeding in 63% of patients. 69% patients had severe vitamin B12 deficiency and 21% had moderate vitamin B12 deficiency.Conclusion: ITS, is commonly seen among male children belonging to lower socio-economic group among age group of 6 months to 24 months, presents with coarse tremors with moderate to severe anemia with moderate to severe acute malnutrition and is associated with deficiency of vitamin B12. Early diagnosis and treatment including nutritional rehabilitation grossly improved the outcome.