CORTICOSTEROIDS

A number of medications are now available for the treatment of asthma.  Which medication is correct for each individual person with depends on the frequency, severity and type of symptoms that are present.  Here you can get information of the different types of asthma medications.

Inhaled Corticosteroids

Chronic inflammation is the major component of persistent asthma.  Corticosteroids are remarkably effective in suppressing the inflammation of asthma, thereby, controlling the disease. For many patients, inhaled corticosteroids can control their symptoms without significant side effects.  The development of inhaled corticosteroids is one of the greatest advancements in the treatment of asthma and for some patients it is the only medication required on a daily basis.

Common inhaled steroids:

Advair Diskus – Fluticasone proprionate plus salmeterol

Symbicort Inhaler - Budesonide plus formoterol

Asmanex Twisthaler– Mometasone furoate

Pulmicort Flexhaler – Budesonide

Pulmicort Respules _ Budesonide solution

Flovent HFA - Fluticasone propionate

Aerobid and Aerobid M – Flunisole

Azmacort - Triamcinolone acetonide

Beclovent - Beclomethasone dipropionate

Drug Action
Corticosteroids decrease inflammation of the airways.  The inhaled form acts directly on the airways and has little effect on the rest of the body when taken in the usual prescribed doses.

Side Effect

Minor fungal infections (thrush) in the mouth and cough, hoarseness and throat irritation other side effects seen occasionally.  Using a spacer device or rinsing the mouth after use can minimize these side effects.

Indications for Use

As a preventative medicine when used routinely.  In can reduce the amount of oral corticosteroids required for the treatment of asthma.

Additional Comments

These drugs do not have a bronchodilator effect and do give immediate relief of symptoms.

Intranasal Corticosteroids

The allergic response is a complex allergy driven mucosal inflammation.  Topical steroids are probably the most effective of the available medications to treat allergic and non-allergic rhinitis. 

Common intranasal steroids

Flonase - fluticasone propionate

Nasonex - mometasone

Rhinocort - budesonide 

Nasarel - flunisolide

Nasacrot AQ - triamcinolone

Beconase AQ - beclomethasone

Veramyst - Fluticasone furoate

Side Effects

Side effects of steroid nasal sprays are usually minor, especially when compared to other forms of corticosteroid delivery. Potential side effects of steroid nasal sprays include:

• Burning sensation in the nose

• Unpleasant aftertaste

• Dryness in the nasal mucous membranes

• Nosebleeds

• Yeast infection

• Hoarseness

• Sore throat

• Cough and bronchospasm

Additional comments

Dryness, hoarseness and related side effects can usually be relieved by gargling and rinsing with water after each inhalation.

Systemic corticosteroids

Despite their effectiveness, oral or systemic corticosteroids carry the risk of side effects if taken long term.   They should only be used in acute exacerbations and for those patients who have failed inhaled steroids.   In general, for acute asthma, the benefit of corticosteroids far outweigh the potential risks and can be life saving.

Common oral steroids:

Decadron

Dexamethasone

Kenalog

Medrol

OraPred

Pediapred

Prednisolone

Prednisone

Prelone

Solumedrol

Drug Action
Corticosteroids decrease inflammation in the airways.  This effect may begin within hours and is secondary to a decrease in the inflammatory cells in the airways.

Potential Side Effects

• Increased appetite/weight gain

• Cataracts

• Osteoporosis (weakening of the bones); can cause growth retardation in children

• Fullness of the face (moonface)

• Elevated blood pressure

• Muscle weakness

• Changes in fat distribution

• Skin changes such as acne

• Bruising more easily

• Salt and fluid retention

• Less resistance to infection

• Diabetes mellitus

• Suppression of normal corticosteroid production

• Menstrual disorders

• Severe chicken pox reaction

If the individual has not had the chicken pox, and are exposed to them while taking oral corticosteroids, they need to notify their physician immediately. The physician may want to alter the steroid dose to prevent severe infection from developing.

Available Forms
Liquids can be mixed with something sweet to be better tolerated; their action becomes effective in 4 to 6 hours.  Tablets are also effective for 4 to 6 hours. Intramuscular injections are also available.  Intravenous injections can be given in the hospital setting.

Additional comments

Oral corticosteroids should be taken as directed by your physician. There is some evidence that a 3:00 PM dosing may be the most effective.  Oral corticosteroids may be used in early treatment of acute asthma exacerbations to prevent a severe attack.  Corticosteroid doses need to be increased at times of increased physical stress such as surgery.  If presently utilizing or if taken regularly within six months of surgery, additional corticosteroids will be needed at the time of surgery, to prevent potential complications.  A calcium supplement may be necessary when on long-term oral corticosteroids. 

The dose of oral corticosteroids should be decreased gradually by those taking corticosteroids for a prolonged period of time because the adrenal glands (glands responsible the making the body’s natural corticosteroids) take time to resume their production.