Use of inhaled steroids to prevent bronchopulmonary dysplasia: a matter of great debate

• Published in: Archives of disease in childhood Vol. 104; no. 9; pp. 924 - 925
• Main Authors: Samiee-Zafarghandy, Samira, van den Anker, John N
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-09-2019
• Subjects: Administration, Inhalation; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - pharmacokinetics; Asthma; Babies; Bronchopulmonary Dysplasia - prevention & control; Budesonide; Corticoids; Corticosteroids; Dose-Response Relationship, Drug; Drug dosages; Dysplasia; Glucocorticoids - administration & dosage; Glucocorticoids - pharmacokinetics; Guidelines as Topic; Health risk assessment; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Infants; Lung diseases; Mechanical ventilation; Metabolism; Mortality; Newborn babies; Pediatrics; Premature birth; Premature Infants; Preschool Children; Respiration, Artificial; Respiratory therapy; Steroid hormones; Steroids; Young Children; Canada; bronchopulmonary dysplasia; inhaled steroids
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2018-316132

Correspondence to Dr Samira Samiee-Zafarghandy, Division of Neonatology, Department of Paediatrics, McMaster University, Hamilton ON L8S 4L8, Canada; [e-mail] In recent years, there has been a significant increase in the use of inhaled corticosteroids for the prevention of bronchopulmonary dysplasia (BPD) in premature infants.1 Studies have shown a decrease in the rate of BPD and need for prolonged mechanical ventilation. The largest study, to date, investigated the early use of inhaled budesonide in preterm infants and showed a significant decrease in the rate of BPD but a higher mortality rate in the exposure group.2 In this study, the causes of mortality did not differ between inhaled budesonide and placebo group, and the difference in the rate of death appeared to originate from a single centre. The CYP3A family of enzymes, which is important in the metabolism of steroids, is functionally immature after birth and reaches adult levels only by 3 years of age.5 Considering the possibility of a high rate of systemic exposure with currently recommended dosing regimen and potential evidence on increased mortality with early use of inhaled steroids, we recommend that any use of these drugs remains under rigorous study protocol which includes PK, dosing and adverse event outcomes.