Inhaled Corticosteroids (ICSs)

ICSs are anti-inflammatory medications that reduce airway hyperreactivity. They are the preferred controller agents for all levels of persistent asthma because they are generally effective and safe at the recommended low to medium dosages. ICSs can reduce the burden of disease and risk of exacerbations in asthma but have been shown not to alter the natural course of the disease in children.

• Children receiving ICSs should be monitored for growth changes by using a stadiometer every 6 months. The potential effect of low- to medium-dose ICSs on growth is usually limited to a reduction in growth velocity (about 1 cm) in the first year of treatment. Children receiving long-term ICSs have been shown to reach their predicted adult height. The decrement in growth velocity varies with ICS.
• When choosing specific ICS products, consider the delivery device the patient uses best and the Food and Drug Administration-approved age for use of the ICS product. See Figure 3-24 for a summary of the various aerosol delivery devices recommended by age and a description of the proper techniques for each.
• Advise patients to rinse their mouth and spit after use of an ICS to decrease oral deposition of the drug.