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 the first-line treatment for patients with mild to moderate persistent asthma. They work by reducing airway inflammation, decreasing mucus production, and preventing airway hyperresponsiveness 1. Common inhaled corticosteroids include fluticasone (Flovent), budesonide (Pulmicort), beclomethasone (QVAR), mometasone (Asmanex), and ciclesonide (Alvesco). For mild to moderate asthma, typical starting doses are fluticasone 88-220 mcg twice daily or budesonide 180-360 mcg twice daily.

Key Points to Consider

• These medications should be taken regularly as prescribed, not just during symptoms, to maintain control of underlying inflammation.
• Proper inhaler technique is crucial for effectiveness—patients should rinse their mouth after use to prevent oral thrush, a common side effect.
• Other potential side effects include hoarseness, cough, and at higher doses, potential systemic effects like adrenal suppression or decreased bone density.
• However, at standard doses, the risk of significant systemic effects is minimal compared to oral corticosteroids.
• Treatment response should be assessed after 4-6 weeks, with dose adjustments made based on symptom control.
• These medications do not provide immediate relief during acute symptoms; a rescue inhaler like albuterol should be used for that purpose.

Evidence Supporting Inhaled Corticosteroids

• Strong evidence from clinical trials suggests that inhaled corticosteroids improve asthma control compared to as-needed beta2-agonists without any other long-term-control medication 1.
• Inhaled corticosteroids have been shown to improve health outcomes for children with mild or moderate persistent asthma, with a well-balanced risk of potential side effects 1.
• The use of inhaled corticosteroids is recommended as the first-line treatment for patients with mild to moderate persistent asthma, based on evidence from multiple randomized controlled trials and meta-analyses 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 recommended as first-line controller medications for persistent asthma 3, 4, 5.
• ICSs suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2) 4.
• The addition of long-acting β-agonists (LABAs) to ICSs further improves asthma control and is commonly given as combination inhalers, which improve compliance and control asthma at lower doses of corticosteroids 4, 6, 7.

Efficacy and Safety 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 3.
• High-dose ICSs had no additional clinical benefit in 3 of the 4 efficacy parameters compared with low or moderate ICS doses for controlling moderate to severe asthma but might have potential safety concerns 3.
• 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 5.

Combination Therapy with Inhaled Corticosteroids and Long-Acting Beta-Agonists

• Single inhaler combination regimens (budesonide/formoterol and fluticasone/salmeterol) were frequently more effective in improving all treatment outcomes than either monotherapy alone 6.
• The combination of an ICS and LABA is preferred in patients with moderate persistent asthma, and this combination is better than doubling or even quadrupling the dose of ICS to achieve better asthma control and reduce exacerbation risks 7.
• An ICS/LABA combination in a single inhaler represents a safe, effective, and convenient treatment option for the management of patients with asthma unstable on inhaled steroids alone 7.