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Dosage, type of inhaler device, and individual drug characteristics influence systemic effects of ICS. Sensitive measures of basal adrenal function can show statistically significant changes during ICS therapy, but these do not accurately predict clinically meaningful adrenal axis suppression. Adrenal insufficiency is rare and confined to children receiving high doses of ICS. Dose\u2010related inhibition of growth has been seen in some short\u2010 and intermediate\u2010term studies, but long\u2010term studies have found no detrimental effect on final height. ICS therapy has not been associated with significant changes in measurements of bone and bone biomarkers, but more studies of high doses and of therapy in adolescents are needed. Overall, although ICS are the most effective anti\u2010inflammatory treatment available for asthma, high doses of ICS in children are still of concern. The risk of high doses is compounded in children with concomitant allergic conditions that require multiple forms of topical corticosteroids. Benefits of ICS clearly outweigh potential adverse effects and risks associated with poorly controlled asthma. Risk can be minimized by using the lowest effective ICS dose, limiting systemic availability of the drug through proper technique to minimize swallowed drug, and selection of agents with efficient first\u2010path hepatic inactivation of swallowed drug. Adjuvant treatments can reduce the dose of ICS required for asthma control, allowing a reduction in overall systemic exposure for most children with mild\u2010to\u2010moderate persistent asthma. Therefore, these agents should be added to, but should not replace, ICS therapy. Pediatr Pulmonol. 2002; 33:208\u2013220. \u00a9 2002 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ppul.10040","type":"journal-article","created":{"date-parts":[[2002,8,25]],"date-time":"2002-08-25T22:20:15Z","timestamp":1030314015000},"page":"208-220","source":"Crossref","is-referenced-by-count":81,"title":["Safety of inhaled corticosteroids in children"],"prefix":"10.1002","volume":"33","author":[{"given":"David B.","family":"Allen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2002,2,4]]},"reference":[{"key":"e_1_2_1_2_2","volume-title":"Expert panel report 2. 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