Steroids to treat asthma: How safe are they?

"There is no question that the administration of corticosteroids reduces the risk and duration of hospital admission in children with acute asthma and remains the most effective treatment for moderate and severe asthma exacerbations," says first author Francine M. Ducharme, a Université de Montréal professor and pediatrician and researcher at the Sainte-Justine University Hospital Research Center. "However, the safety profile of these medications continues to raise concerns among parents and physicians. Concerns over their possible impact on the immune system stem from few rare reports linking or severe chickenpox infections linked with corticosteroid administration."

Reduced immune response to new triggers

Ducharme and colleagues evaluated the immune response of children aged 3 to 17 years, who had arrived at the emergency department (ED) with an asthma attack. All subjects were given immune triggers (known as antigens) and the immune response between those who received corticosteroids versus those who did not were compared.

"Several corticosteroid-treated children had a lower immune response, as measured by the amount of antibody produced, than non-treated kids," says Ducharme.

Reduced immunity only transient

Children enrolled in the study were re-vaccinated with the antigen five weeks following their initial ED visit. Comparable immune responses were measured in children exposed to oral corticosteroids and not exposed to corticosteroids.

"These findings indicate there may be a very transient immune suppression only in some children exposed to a new antigen at the same time as a corticosteroid administration," says Ducharme.

"In summary, our findings suggest a very transient immune suppression occurs in some children who are concomitantly exposed to a new antigen and corticosteroids during an asthma attack, with a recovery within six weeks."

"Given the high frequency of use of these drugs over the past 20 years, the very rare occurrence of severe infectious disease is reassuring and would suggest that the window of risk is very small and only applies to exposure to a new antigen. However, before prescribing oral corticosteroids, it would appear prudent to systematically enquire about recent exposure to chickenpox in children who did not have chickenpox or the vaccine," adds Ducharme. Moreover, all children with asthma who have not had chickenpox should be vaccinated for this condition.