Inhaled corticosteroids

Inhaled corticosteroids therapy is the cornerstone of the long-term treatment of asthma.

Considered the most effective therapy for asthma.

Can cause systemic and local adverse effects.

In COPD, modest improvements in lung function occur and significant decreases in exacerbation rates are noted when inhaled corticosteroids are added to combined LAMA and LABA therapy.

Inhaled corticosteroid therapy carries less risk of complications or disease-related morbidity and mortality than that associated with other antiasthmatic drugs such as systemic steroids, theophylline, or beta2-agonist bronchodilators.

Serious side effects are uncommon.

Risk of complications to ICS increases with the daily dose.

Complications include: pneumonia, thrush, hoarseness, and skin bruising.

May be associated with ocular symptoms, growth velocity reduction in children, and altered bone metabolism.

Systemic adverse effects include dysphonia, oral pharyngeal candidiasis, and pharyngitis.

Inhaled glucocorticoids, long-acting beta 2 agonists, and long acting muscarinic antagonists reduce the frequency of acute exacerbations of COPD, but patients receiving all 3 of these medications may still have as many as 1.4 acute exacerbations, on average, each year(Aaron SD et al).

Inhaled corticosteroids (ICSs) does not improve the acceleration rate of lung function decline in patients with mild to severe COPD, but it does reduce frequency of acute exacerbations and improved health status and symptoms of COPD.

Regular treatment with inhaled corticosteroids in patients with and FEV1 of less than 60% improve symptoms and quality-of-life and may reduce exacerbations.

Inhaled corticosteroids may cause alterations in voice quality, candidiasis, and increased risk for pneumonia.

There is a 1.57 fold increase of bacterial pneumonia in the use of inhaled corticosteroids for COPD.

Older patients may have a reduced response and potentially require higher doses to achieve asthma control.

Older patients may have adverse effects including: skin thinning, increased risk of bruising, and wearing of dental prosthetics may increase the risk of oral thrush.

Estimated that 50-70% of patients with COPD use ICS’s with long-acting beta-adrenergic agonist bronchodilators.

Meta-analyses show a 50-70% increase in risk of pneumonia associated with the use of ICSs in COPD and the risk is mostly associated with high doses of fluticasone proprionare and not budesonide or ciclesonide.

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