Pulmonary and adrenal effects of alternate-day corticosteroid therapy

Beclomethasone aerosol in childhood asthma

“…There are, however, about 25% of such children in whom sodium cromoglycate has little or no effect Received 5 March 1973. and who consequently require steroids. Growth suppression and adrenal suppression can be avoided by giving a double dose of steroids on alternate mornings (Zachmann, 1970;Falliers et al, 1972) but, in our experience, control of symptoms on the intermediate day is not very good. The only remaining course for the severe asthmatic is to give corticotrophin (Friedman and Strang, 1966), which means injections at intervals of 2 to 3 days.…”

“…At the end of 3 months on beclomethasone, resting plasma cortisol was within the normal range (Falliers et al, 1972) in all the children and the response to tetracosactrin was also normal (Table III). No abnormality was detected in haematology, liver function, urea, electrolytes, urine analysis, or blood pressure in any child.…”

Effects of corticosteroid inhalation therapy on the deposition pattern of Tc-99m human serum albumin radioaerosols in asthma

“…Because this test is simple and noninvasive, it may be used as a quarttitative tool to assess the pharmacologic effect of corticosteroid inhalation treatment in asthma patients. Multiple mechanisms responsible for the beneficial effect of corticosteroids have been proposed as follows [2,4,6,7]: anti-inflammatory effects, delays and/or partial inhibition of reaccumulation of intracellular histamine after discharge, reversed f3-adrenergic blockade, inhibition of phosphodiesterase activity, and increased intracellular cAMP activity. In addition, it is reasonable to expect that corticosteroids improve the mucociliary clearance mechanism in the lungs, because they are known to show favorable effects on ciliary beats and mucous secretion in vitro [2,4,6,7].…”

“…Multiple mechanisms responsible for the beneficial effect of corticosteroids have been proposed as follows [2,4,6,7]: anti-inflammatory effects, delays and/or partial inhibition of reaccumulation of intracellular histamine after discharge, reversed f3-adrenergic blockade, inhibition of phosphodiesterase activity, and increased intracellular cAMP activity. In addition, it is reasonable to expect that corticosteroids improve the mucociliary clearance mechanism in the lungs, because they are known to show favorable effects on ciliary beats and mucous secretion in vitro [2,4,6,7]. The development of beclomethasone dipropionate has provided a topically active agent with minimal systemic side effects, but all of the actions of beclomethasone dipropionate aerosol inhalation are still obscure [5,8].…”

Asthma in Childhood

“…Single-dose, alternate-morning therapy with corticosteroids such as prednisone, prednisolone or methylprednisolone which have short half-life values and cause little sodium retention minimizes adverse effects, yet controls chronic asthma in children. 81 Wheezing may increase on the day the child is "off" steroids.…”