The new long lasting and high potency beta2-agonists like salmeterol (Serevent), soon to be available for children, which control asthma symptoms for 12 hours at a puff, could exacerbate the problem.

Steroids used for asthma control pose many more risks than previously thought. Many doctors are turning to steroids as a first port of call after all the recent bad press for beta2-agonists. But recent studies have shown that inhaled steroids (which were supposed not to pose the usual risks that swallowed ones do) are not as harmless as medicine previously supposed. The consensus up until now has been that beclomethasone dipropionate (BDP) of 400-800 ug daily is appropriate for the 3-5 year old age group. However, a group of paediatric consultants from various hospitals in Britain wrote to the Lancet (14 December 1991) to point out various studies showing that this dose of BDP was the equivalent of 20-40 mg of prenisoline in causing suppression of the adrenal and pituitary glands. This dosage also produced significant growth retardation in a group of children studied.

Inhaled steroids have also caused symptoms characteristic of Cushing's syndrome: obesity, moon face, thinning skin and stretch marks, as well as bruising.

Another unforeseen risk is that many otherwise benign infections become life threatening in children on drugs like steroids, which suppress the immune system. America's Food and Drug Administration has asked manufacturers of all steroids to add the following warning on all drug packs: "Children who are on immunosuppressant drugs are more susceptible to infections than healthy children. Chickenpox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. " Besides the disease itself, the risks of vaccination multiply (particularly with one employing a live virus) if a child's immune system has been suppressed.

As for adults, some studies have shown that even low doses of inhaled beclomethasone (400 ug) per day) reduce bone formation (The Lancet 6 July 1991). Deaths from lack of adrenal gland function have occurred when patients have switched from oral to inhaled steroids without overlapping the drugs. There is also the problem of recurrent thrush of the mouth.

Because some of the drug escapes into the blood stream, even when inhaled, people on high doses run the usual risks of steroids. These include over activity of the adrenal glands, which produces Cushing's disease, a fat abdomen, buffalo hump in the back of the neck, high blood pressure and muscle weakness.

Steroids can also cause muscle wasting, hyperglycaemia, water retention, skin atrophy, bruising and stretch marks, insomnia, serious mood changes, symptoms of schizophrenia or manic depression, possibly cataracts or glaucoma, menstrual problems, impotence, loss of libido or even allergic shock. More dangerously, prolonged use of steroids causes the pituitary gland to stop producing ACTH, a hormone which regulates the adrenal glands, needed by the body during stress.

All this in a drug which can only suppress inflammation, not cure it, by constantly masking what is undoubtedly a healthy allergic response.