Conversely, if control is not achieved, a patient's inhalation technique, compliance and environmental control measures need to be reassessed. For severe persistent asthma both inhaled and oral corticosteroids may be required. While the use of inhaled corticosteroids limits the systemic side effects of the drugs in comparison to oral corticosteroids, concerns persist. For example, chronic use of inhaled corticosteroids has been shown to lead to a slight dose-dependent adrenal suppression, although adrenal reserves appear to be adequate even with high doses of inhaled corticosteroids. However, there appears to be a consensus that inhaled corticosteroids are relatively safe.
Growth rates are highly variable in children.
Short-term evaluations may not be predictive of attaining final adult height. Poorly controlled asthma may delay growth in children. In general, children with asthma tend to have longer periods of reduced growth rates prior to puberty. The potential for adverse effects on linear growth from inhaled corticosteroids appears to be dose-dependent. In treating children with mild to moderate persistent asthma, medium-dose inhaled corticosteroid therapy may be associated with a possible, but not predictable, adverse effect on linear growth.