Benefit Versus Risk for Oral, Inhaled, and Nasal Glucocorticosteroids

Glucocorticosteroids, whether administered orally, by inhalation, or nasally, can be extremely beneficial when treating allergic inflammation in the upper and lower airways but they can also have adverse effects. Many factors affect the balance of benefit and risk in the individual, but there are no hard units by which the two can be quantified and weighed against each other. This article considers in broad terms the factors that may influence the benefit/risk ratio in an individual and the net effect from a public health perspective. In general, the optimal benefit/risk ratio is achieved with topical administration and the lowest dose of inhaled or nasal glucocorticosteroid that controls symptoms, and, in the case of asthma, prevents exacerbations and the need for oral glucocorticosteroids.