Inhaled glucocorticoids (ICS) have become the first-line medication for all patients with persistent symptoms of asthma, and there is consensus that ICS is central to asthma treatment in terms of the GINA guidelines’ stepwise treatment protocol, which includes ICS for all levels of treatment above level 2. Some asthma patients are reluctant to use hormones, even inhaled hormones, to the great detriment of treatment, and physicians must correct this dangerous perception in their patients. Why are they reluctant to use hormones (even ICS)? The reason is simple: he/she fears that the adverse effects of hormones may occur in him/her (or in a son or daughter with asthma). In fact, the adverse effects of ICS are definitely less than those of systemic hormones (oral or intravenous), so let’s see how to perceive them properly. ● Difficulty in pronunciation: This is highly related to the inhalation device. Studies have shown that hoarseness (dysphonia) occurs in 50% of patients who apply MDIs, whereas it occurs at a lower rate with dry powder formulations and generally disappears after discontinuation of the drug. This adverse reaction may have less effect on the general population and may inconvenience singers or lecturers. So please remember to advise your patients to rinse their mouths promptly after inhaling the hormone to minimize local adverse reactions. ● Candida infection of the oropharynx (thrush): It is more common in the elderly and in patients who use ICS consistently more than twice a day. Same advice, remember to rinse your mouth after medication! ● Lower respiratory tract infections: This is a topic of great concern. There are no definitive studies that show that long-term ICS increases the chance of lower respiratory tract infections. Because the core of asthma treatment is inhaled hormones, even though there may be adverse reactions of one kind or another, inhaled hormones should not be discontinued as long as they are not too severe. Systemic adverse reactions The systemic effects of ICS are much less than those of systemic hormone use (including oral and intravenous hormones), and the systemic effects of ICS depend on the amount of drug absorbed into the systemic circulation. Long-term studies have not shown significant inhibition of growth, bone metabolism, or the hypothalamic-pituitary-adrenal axis (HPA axis) in children with low-dose ICS therapy. ● Effects on the HPA axis: There are numerous studies in this area with mixed results. The current consensus is that ICS does not significantly inhibit the function of the HPA axis when applied at no more than 1500 μg per day in adults and 400 μg per day in children. It is not possible to stop using ICS for fear of inhibiting the HPA axis, which is somewhat of a choking effect. ● Effects on growth and development: This is particularly important in childhood asthma. It must be stated that poorly controlled asthma can itself affect the growth and development of children. Research on the effects of growth due to asthma versus the effects of ICS on growth is complex. Many studies have shown that ICS does not have an effect on the final height of the child, but given the specific nature of ICS, children with asthma should use ICS correctly under the guidance of a physician and avoid overuse of hormones (including dose, duration of therapy, etc.). ● Effects on bone metabolism: There is a consensus on the effects of long-term oral hormone administration on osteoporosis and its adverse effects leading to spine and rib fractures. However, there is no conclusive evidence whether long-term ICS increases the risk of fracture. It is currently believed that ICS does not increase the risk of fracture in patients and that long-term ICS application does not have an effect on bone mineral density. On the contrary, elderly asthmatic patients with ICS have improved their condition and mobility and increased their bone mineral density instead. ●Impact on pregnancy: Pregnant women with asthma, if not treated promptly and effectively, will not only affect the pregnant woman herself but also the fetus, so proper control of asthma in pregnancy is important. The core of asthma treatment is ICS! Numerous clinical studies have shown that ICS is safe in pregnancy and that aggressive treatment of pregnant women with asthma is more important than the potential side effects of any medication (including ICS) (Level A evidence). The hormone most commonly used to control asthma in pregnancy is budesonide. In conclusion, the core of asthma treatment is glucocorticoids, and as long as the adverse effects of ICS are properly recognized and avoided as much as possible, the benefits far outweigh the disadvantages for asthma patients!