What are the effects of inhaled corticosteroids (ICS)?

From the Guidelines

Inhaled corticosteroids are the most effective long-term control medication for asthma, and their use is recommended as first-line therapy for patients with persistent asthma. The evidence from multiple studies, including those published in the Journal of Allergy and Clinical Immunology 1, and the American Family Physician 1, consistently shows that inhaled corticosteroids improve asthma outcomes, including symptom scores, exacerbation rates, and quality of life.

Key Points to Consider

• Inhaled corticosteroids, such as fluticasone (Flovent), budesonide (Pulmicort), beclomethasone (QVAR), mometasone (Asmanex), and ciclesonide (Alvesco), are effective in reducing airway inflammation, decreasing mucus production, and preventing airway hyperresponsiveness 1.
• Typical starting doses for adults with asthma range from low to medium strength, such as fluticasone 88-220 mcg twice daily or budesonide 180-360 mcg twice daily, adjusted based on symptom control 1.
• Proper inhaler technique is crucial for effectiveness, and patients should rinse their mouth after use to prevent oral thrush, a common side effect 1.
• Other potential side effects include hoarseness, cough, and rarely, adrenal suppression with high doses 1.
• Inhaled corticosteroids are not for immediate symptom relief but rather for long-term control, requiring consistent daily use even when symptoms are absent 1.
• Treatment should be regularly reassessed, with the goal of using the lowest effective dose to maintain control while minimizing side effects 1.

Special Considerations

• There are no clinically meaningful differences among the various types of inhaled corticosteroids 1.
• Smokers may have a decreased responsiveness to inhaled corticosteroids, possibly due to persistent irritation and scarring 1.
• Black children may have an increased risk of corticosteroid insensitivity due to deficiencies in T cell pathways 1.
• Systemic effects of inhaled corticosteroids may occur but are typically not clinically important, except with long-term use 1.

From the FDA Drug Label

Budesonide inhalation suspension is an inhaled corticosteroid medicine Budesonide inhalation suspension is a long-term maintenance medicine used to control and prevent asthma symptoms in children ages 12 months to 8 years. Inhaled corticosteroids help to decrease inflammation in the lungs. Inflammation in the lungs can lead to asthma symptoms Budesonide inhalation suspension helps reduce swelling and inflammation in the lungs, and helps keep the airways open to reduce asthma symptoms.

Inhaled Corticosteroids are used to control and prevent asthma symptoms by decreasing inflammation in the lungs. Budesonide inhalation suspension is a type of inhaled corticosteroid that helps reduce swelling and inflammation in the lungs, keeping the airways open to reduce asthma symptoms 2.

From the Research

Inhaled Corticosteroids Overview

• Inhaled corticosteroids (ICSs) are the most effective controllers of asthma, suppressing inflammation by switching off multiple activated inflammatory genes 3.
• ICSs are recommended as first-line controller medications for persistent asthma, controlling asthma symptoms and preventing exacerbations 4, 3.

Efficacy of Inhaled Corticosteroids

• All starting doses of ICSs were comparable with respect to nighttime rescue medication use, nighttime symptom score, change in forced expiratory volume in 1 second, and study withdrawal because of an adverse event 4.
• High-dose ICSs and low- and moderate-dose ICSs with long-acting β-agonists showed significant improvement in morning peak expiratory flow compared to low-dose ICSs 4.
• Fluticasone propionate was more effective than leukotriene receptor antagonists (LTRAs) in clinical outcomes, producing greater improvements in lung function and asthma control 5.

Safety of Inhaled Corticosteroids

• ICSs have minimal systemic effects in most patients when taken at recommended doses, with minimal ocular effects, effects on bone mineral density, and adrenal function 6.
• One-year growth studies in children have shown decreased growth velocity with ICSs, but long-term studies show no effect on final adult height, suggesting that these effects are transient 6.
• Extensive data from the Swedish Medical Birth Registry show no increased risk of adverse perinatal outcomes when inhaled budesonide is administered to pregnant women with asthma 6.

Combination Therapy

• Single inhaler combination regimens (budesonide/formoterol and fluticasone/salmeterol) were frequently more effective in improving all treatment outcomes than either monotherapy alone 7.
• Combination therapy with ICSs and a long-acting beta2-agonist is recommended as initial maintenance therapy if the disease is of sufficient severity 5.