From the Guidelines
Inhaled corticosteroids (ICS) can be used in patients with mild persistent asthma and a history of recurrent ocular herpes, but with careful monitoring and consideration of the potential risks. For these patients, low-dose ICS options are preferred, as stated in the guidelines for mild persistent asthma management 1. The preferred treatment includes low-dose inhaled corticosteroids, which can be administered via a nebulizer or a metered-dose inhaler (MDI) with a holding chamber, with or without a face mask, or a dry powder inhaler (DPI) 1.
Key Considerations
- The use of ICS in patients with a history of recurrent ocular herpes requires careful monitoring for signs of herpes reactivation, such as eye pain, redness, or vision changes.
- Patients should maintain regular ophthalmologic follow-up to monitor for any herpes recurrence.
- If signs of ocular herpes activation occur, the patient should contact their healthcare provider immediately, as the ICS dose may need adjustment or temporary discontinuation.
- The concern with corticosteroids in patients with herpes history stems from their immunosuppressive effects, which could potentially reactivate latent herpes virus.
- However, the systemic absorption of properly administered ICS is minimal, making the risk of herpes reactivation significantly lower than with oral corticosteroids 1.
Management Approach
- For patients with frequent herpes recurrences, prophylactic antiviral therapy might be considered alongside ICS treatment, especially during periods of asthma exacerbation when higher doses of corticosteroids might be needed.
- Low-dose ICS options like fluticasone propionate, budesonide, or beclomethasone are appropriate choices for these patients, as they are effective in managing mild persistent asthma while minimizing the risk of systemic side effects 1.
Evidence Basis
The recommendation to use ICS in mild persistent asthma is based on the guidelines that suggest inhaled corticosteroids as the preferred treatment option for mild persistent asthma in adults and children 1. Although the guidelines do not specifically address the use of ICS in patients with a history of recurrent ocular herpes, the general principle of using the lowest effective dose of ICS to control asthma symptoms while minimizing potential side effects applies 1.
From the FDA Drug Label
ICS should be used with caution, if at all, in patients with active or quiescent tuberculosis infections of the respiratory tract; systemic fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex.
Inhaled corticosteroids (ICS) can be used in patients with mild persistent asthma and a history of recurrent ocular herpes, but with caution. The FDA drug label recommends using ICS with caution in patients with ocular herpes simplex, indicating that it is not entirely contraindicated, but careful consideration should be taken when prescribing ICS to these patients 2.
From the Research
Inhaled Corticosteroids in Mild Persistent Asthma
- Inhaled corticosteroids (ICS) are recommended as the preferred treatment for patients with mild persistent asthma 3, 4.
- Studies have shown that ICS are effective in controlling asthma symptoms and improving lung function in patients with mild persistent asthma 5, 6.
History of Recurrent Ocular Herpes
- There is limited evidence on the specific use of ICS in patients with a history of recurrent ocular herpes.
- However, one study found that the use of ICS was not a significant risk factor for the occurrence of herpes zoster, including ocular herpes 7.
- Another study discussed the safety of ICSs with respect to potential systemic effects, including ocular effects, and found that these effects are minimal in patients maintained on recommended ICS doses 4.
Use of Inhaled Corticosteroids in Patients with Mild Persistent Asthma and a History of Recurrent Ocular Herpes
- Based on the available evidence, it appears that ICS can be used in patients with mild persistent asthma and a history of recurrent ocular herpes, as the benefits of ICS therapy outweigh the risks of uncontrolled asthma 4.
- However, patients with a history of recurrent ocular herpes should be closely monitored for any signs of herpes reactivation while taking ICS 7.
- The decision to use ICS in these patients should be made on a case-by-case basis, taking into account the individual patient's medical history and the potential risks and benefits of treatment 3, 4.