Inhaled steroids and severe viral infections.

In summary, the blanket inclusion of inhaled corticosteroids in the recent FDA label warning of an association between severe varicella infection and corticosteroid therapy without reference to dosage, and proof of immunosuppression and subsequent increased risk, dose not appear warranted. To date, no link has been established between inhaled steroids and pulmonary or systemic infections. Certainly, with the recent trend of use of higher doses of inhaled corticosteroids, a potential association is possible, but so far, this is only theoretical. Since inhaled corticosteroids have become the recommended drug of choice for many patients with asthma of varying disease severity, according to new recommendations from the National Heart Lung and Blood Institute (38), it is imperative that a sound basis of proof be provided to support this labeling change. It must be realized that this new warning may lead to adverse consequences resulting from the withholding by the patient or physician of a valuable mode of therapy for fear of adverse effects to the patient. Avoidance of inhaled steroid usage, in turn, could result in overuse of other medication that has more definite and frequent deleterious effects than the theoretical risks associated with inhaled steroids. Given the above information and arguments, a number of constructive recommendations about how to proceed at this time can be proposed.