Main theme: Airway/General
Introduction: Systemic glucocorticoids are integral to the management of acute exacerbations of subglottic stenosis (SGS), but long-term use carries well-documented adverse effects. Emerging adult evidence links cumulative lifetime doses of 500–1000 mg prednisolone-equivalent to increased systemic risk, while emerging paediatric literature proposes an annualised threshold of 100 mg/year, reflecting the greater relevance of dosing pattern and growth-window timing in children. Neither benchmark has been applied to paediatric SGS. This study aimed to quantify cumulative and annualised corticosteroid exposure and associated systemic adverse effects in this population.
Methods: Patients aged <16 years with a diagnosis of SGS managed at a tertiary paediatric ENT centre over a 10-year period were identified. Corticosteroid prescriptions (dose, route, indication) were extracted from electronic records and converted to prednisolone-equivalent doses using standard conversion factors. Systemic biomarkers, including adrenal suppression and growth/weight parameters, were recorded.
Results: 70 patients met inclusion criteria (mean age 2.7 years, 70% male). A total of 736 corticosteroid doses were prescribed, with a median per-patient cumulative dose of 75 mg prednisolone-equivalent. 12 patients (17%) exceeded the proposed 100 mg/year threshold and 5 (7%) exceeded 500 mg total dose.
Conclusion: Children with SGS accrue substantial, often unmonitored, systemic corticosteroid exposure. As no validated paediatric threshold exists for lifetime cumulative dose, these findings support routine tracking of both cumulative and annualised exposure, multidisciplinary input from paediatric endocrinology, and exploration of steroid-sparing strategies to reduce iatrogenic burden in this population.
References
Horton, D. (2020). Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children. Am J Epidemiol., 190(3), 403-412. https://pmc.ncbi.nlm.nih.gov/articles/PMC8086240/
Scheire, S. (2026). Meta-Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force. Allergy, Online ahead of print(na), na. https://pubmed.ncbi.nlm.nih.gov/42011838/
Soliman, A. (2022). The Long-term (five years) Effects of Prednisone Therapy in Children with Frequently Relapsing Nephrotic Syndrome: A Controlled Study of Anthropometric Parameters and Metabolic Abnormalities. https://pmc.ncbi.nlm.nih.gov/articles/PMC9686183