For how we live.
Croup gives young children a barking cough and noisy breathing. It is usually mild and self-limiting, and a single dose of oral steroid shortens it — with a low dose working about as well as a high one.
Two large trials, ETHOS and IMPACT, found adding an inhaled steroid to a two-bronchodilator inhaler lowered exacerbation rates in COPD — at the cost of more pneumonia.
Guidelines now ask for an objective test before an asthma label is fixed to a child, and inhaled steroids remain the mainstay of control. Their benefit is real; so is a small, mostly temporary effect on growth.
Adding an inhaled steroid to the as-needed inhaler roughly halved severe attacks against a short-acting reliever, at a fraction of the daily steroid exposure that maintenance therapy delivers.