ABSTRACT
Glucocorticoids have been used in the treaunent of asthma for many years and are now a cornerstone of asthma therapy. Recent attention has been paid to the mechanisms of glucocorticoids and their effects on the wide array of inflammatory cells thought to be important in the pathophysiology of asthma. Innovations such as administration by the inhaled route have been designed to optimize therapy. A number of questions remain and controversial issues have arisen regarding inhaled glucocorticoids, particularly in the treaunent of children with asthma. These include the risk for systemic adverse effects and the equivalent potency of the various inhaled glucocorticoids as they relate to each other. Further complicating these issues will be the future introduction of newer inhaled glucocorticoids (budesonide and ftuticasone propionate) thought to be more potent with less risk for systemic adverse effects (although this remains highly controversial at the present time). Novel inhaled drug delivery systems (alternative propellants for metered-dose inhalers and dry powder inhalers), which can alter deposition of drug to the lungs and airways and ultimately may affect the efficacy and safety profile of inhaled glucocorticoids, will also confound comparisons of the different products. Finally,
*Current affiliation: Glaxo Wellcome Inc., Research Triangle Park, North Carolina.
