State of art of oral corticosteroids in children with acute asthma and wheezing

BACKGROUND: Oral corticosteroids (OCS) are widely used in the management of pediatric asthma exacerbations and recurrent wheezing. Despite their established efficacy, concerns about safety, optimal dosing, and appropriate clinical contexts persist. METHODS: This narrative review synthesizes evidence from studies published between 2000 and 2025, focusing on the efficacy, safety, and clinical applications of OCS in children. Pharmacological data were also included from earlier literature. RESULTS: Evidence indicates that OCS remain essential for managing moderate-to-severe asthma exacerbations in school-age children. In preschool wheezing, their benefit is inconsistent and appears limited to selected subgroups, such as children with virus-associated wheezing or established asthma. Short courses and lower doses provide comparable efficacy with improved tolerability. Among the available molecules, dexamethasone has emerged as a promising alternative due to better palatability and adherence, while deflazacort shows comparable efficacy but requires further validation. CONCLUSIONS: The role of OCS in pediatric respiratory disease should be individualized, balancing efficacy and safety. Future studies should refine patient selection and evaluate alternative corticosteroid molecules to optimize therapeutic strategies.