Inhaled glucocorticoid therapy in infants at risk for neonatal chronic lung disease.
The primary impetus for the study of inhaled glucocorticoid therapy in the treatment and prevention of neonatal chronic lung disease (CLD) was to achieve effective anti-inflammatory therapy with few adverse effects. Initial reports of inhaled glucocorticoid therapy in infants with established CLD suggest modest improvement in neonatal respiratory outcomes. Recent randomized trials also indicate that inhaled glucocorticoid therapy may provide some benefit, but have not demonstrated a reduction in CLD. Some studies suggest that the pulmonary response to systemic glucocorticoid may be greater and faster than response to inhaled glucocorticoid therapy. Few adverse effects have been noted with inhaled glucocorticoid therapy. One limitation of studies of inhaled glucocorticoid therapy is the uncertainty of the dose delivered and deposited in peripheral airways and regions of the lungs. Experience with and systematic study of inhaled glucocorticoid therapy is still in its early stages. The role of inhaled glucocorticoid therapy in the treatment and prevention of CLD is evolving. Advances in delivery devices and new developments of drug formulations should improve aerosol delivery and deposition in infants. Given the clinical dilemma of systemic glucocorticoid therapy and potential benefits demonstrated by recent trials of inhaled glucocorticoid therapy, further study of inhaled glucocorticoid therapy for CLD is warranted.
Cole
C H
CH
Boston Floating Hospital for Children, New England Medical Center, Tufts University School of Medicine, Massachusetts 02111, USA.
D000280:Administration, Inhalation; D000287:Administration, Topical; D000336:Aerosols; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy / Q000517:prevention & control*; D005938:Glucocorticoids; D006801:Humans; D007231:Infant, Newborn
D000336:Aerosols; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids