Uncertainties still surround high dose inhaled corticosteroids (ICS) use in asthma. In hindsight, certain aspects of the ICS development story can help elucidate why. In 1973, Cameron et al. [1] signed a brilliant paper reporting the results of a double blind, randomised controlled trial demonstrating the oral corticosteroid (OCS)-sparing effect of ICS as the primary outcome. A few years later, the assessment of this benefit was mitigated when a complete weaning of OCS remained unachievable [2]. The benefit of ICS was therefore understood to be mostly based on an improved safety profile purportedly due to reduced systemic diffusion. Thus, the understanding of how ICS was of any benefit to asthma patients when compared to OCS was mostly based on a greater safety profile supposedly due to a reduced systemic diffusion. Similarly, topically administered corticosteroids were also developed in the same time period for diseases affecting the skin, the eyes, the nose or the joints. As for ICS, whether or not these formulations reduce corticosteroid-associated adverse events remains largely debated [3]. If high doses of ICS are equivalent to low dose OCS, they should be considered as such http://bit.ly/2CYssfB

中文翻译：

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将高剂量吸入皮质类固醇纳入口服皮质类固醇管理

哮喘中使用高剂量吸入皮质类固醇 (ICS) 仍存在不确定性。事后看来，ICS 开发故事的某些方面可以帮助阐明原因。1973 年，卡梅伦等人。[1] 签署了一篇出色的论文，报告了一项双盲、随机对照试验的结果，该试验证明 ICS 的口服皮质类固醇 (OCS) 保留作用是主要结果。几年后，当 OCS 的完全断奶仍然无法实现时，对这种益处的评估就减弱了 [2]。因此，人们认为 ICS 的好处主要是基于据称由于减少全身扩散而提高的安全性。因此，与 OCS 相比，对 ICS 如何对哮喘患者有益的理解主要基于更高的安全性，据称是由于全身扩散减少。相似地，在同一时期还开发了局部给药的皮质类固醇，用于影响皮肤、眼睛、鼻子或关节的疾病。至于 ICS，这些制剂是否能减少皮质类固醇相关的不良事件仍存在很大争议[3]。如果高剂量 ICS 等同于低剂量 OCS，则应视为此类 http://bit.ly/2CYssfB