Is long-term treatment with inhaled steroids in adults hazardous?

Since the introduction of inhaled steroids for the treatment of asthma, numerous studies have shown that they have an advantageous therapeutic index in relation to oral steroids, as well as high potency. They certainly represent a major 3:dvance in asthma treatment. Initially, inhaled steroids were used in moderate doses and primarily as a substitute for oral steroids. In recent years we have seen a tendency to prescribe inhaled steroids in higher doses than previously used [1, 2]. They have also been advocated in low doses at an earlier stage in the treatment [2, 3]. If steroids are to be used at an earlier stage in asthmatics with relatively mild symptoms, any significant side-effect must be considered on its own, rather than being compared with the side-effects of oral steroids. The question of how harmless the treatment with topical steroids is must be raised.