ABSTRACT
The inclusion of low-dose glucocorticoid treatment as an emerging therapy for bronchopulmonary dysplasia (BPD) signals a new chapter in the chronicle of glucocorticoids and BPD. That this new chapter is entitled “low-dose” glucocorticoid treatment is also ironic, signaling as it does that instead of the usual approach to new drug testingstarting with a low dose and escalating after evaluation of efficacy and safetyglucocorticoid therapy for BPD began with very high doses of the powerful synthetic glucocorticoid dexamethasone. Only after documentation of myriad adverse effects, including growth failure and long-term neurodevelopmental compromise, did the pendulum swing away from widespread use of high-dose dexamethasone to a very restricted use of any glucocorticoid for BPD. Careful reevaluation of these therapeutic agents in lower doses and alternate preparations may ultimately lead to the emergence of a more nuanced approach to glucocorticoid therapy for this challenging disease, resulting in net benefit. This chapter first briefly reviews the history of glucocorticoid therapy for BPD, then presents the rationale for lower dose therapy, examines differences in glucocorticoid preparations, reviews current data regarding lower dose therapy, and finally, discusses future directions for research.
