Pro-con debate: Inhaled corticosteroids should not be prescribed in primary care to children under two years of age - the case against.

Asthma is difficult to diagnose in children under 2 years of age and there is a dearth of clinical studies using inhaled corticosteroids in this age group. Guidelines advise caution in both diagnosis and treatment but do recommend a trial of inhaled corticosteroids if respiratory symptoms are severe. Clinical studies have been published showing symptoms can be improved with inhaled corticosteroid usage. If their dosages are kept well within the licensed range the risks of adverse events and clinically relevant side effects are small. To deny very young children the opportunity of clinical benefit from the use of inhaled corticosteroids in this age group is not acceptable. Processes need to be in place to ensure inhaler technique is adequate and assessment of clinical outcomes is robust.