The speed of action and side-effects of systemic verus inhaled steroids was compared in infants with mild-moderate oxygen dependency. Forty infants (median gestational age 27 weeks) were randomized to receive either 10 days of dexamethasone (systemic group) or budesonide (100 micrograms qds) (inhaled group). At randomization, there was no significant difference in the gestational or postnatal age, inspired oxygen requirements or compliance of the respiratory system of the two groups. After 36 h of treatment, there were significant changes (P < 0.01) in both the inspired oxygen concentration and compliance of the respiratory system in the systemic but not the inhaled group. Only after 1 week of inhaled therapy were improvements in respiratory status noted but, even at that time, the inspired oxygen requirement was significantly lower in the systemic versus the inhaled group. In the systemic group only, however, were there significant increases in blood pressure.
Conclusion: Systemically administered rather than inhaled steroids appear to have a faster onset of action.