Dangers of Under-treatment and Over-treatment with Inhaled Corticosteroids in Children with Asthma

Two children, both under the care of specialists for mild persistent asthma, flirted with mortality. One lost and one won the battle. A 16-year-old boy never received ICS therapy despite extensive airway inflammation and remodeling and died due to mismanagement of an asthma exacerbation. A 6-year-old girl developed iatrogenic Cushing's syndrome during 18 months of continuous treatment with high, FDA-unapproved doses of both ICS and INCS and nearly died during an adrenal crisis. The role of ICS under-treatment and over-treatment and the possibility that recommendations in asthma guidelines and information in FDA package labels could have prevented both outcomes are explored.