Assessing the therapeutic index of inhaled corticosteroids in children: Is knemometry the answer?

Since the introduction of topical inhaled corticosteroids (ICSs) for the treatment of asthma decades ago, there have been concerns about potential risks from systemic activity.1 This has been particularly true regarding ICS use in young children, in whom growth and development represent additional issues.2 Despite the ongoing development over the years of newer ICS molecules with pharmacokinetic properties that improve the therapeutic index (ratio of topical activity to systemic activity), such as decreased oral bioavailability, rapid systemic clearance, and lung retention (Fig 1), all ICSs still work by stimulating glucocorticoid receptors, which are found throughout the body.

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