What are the indications for glucocorticoid (inflammatory steroid) therapy in mild asthma?

From the Guidelines

Inhaled corticosteroids (ICS) are the preferred glucocorticoid therapy for mild asthma, typically used as needed or as daily maintenance. For as-needed treatment, a low-dose ICS like beclomethasone (40-80 mcg per puff) or budesonide (90-180 mcg per puff) can be taken together with a short-acting beta-agonist (SABA) like albuterol when symptoms occur. For daily maintenance, low-dose ICS options include fluticasone propionate (88-110 mcg twice daily), budesonide (180-360 mcg twice daily), or beclomethasone (40-80 mcg twice daily) 1. Treatment should continue for at least 3 months to assess effectiveness. Proper inhaler technique is essential—patients should rinse their mouth after use to prevent oral thrush. These medications work by reducing airway inflammation, decreasing mucus production, and preventing airway hyperresponsiveness. ICS therapy helps control symptoms, reduce exacerbations, and improve lung function while having minimal systemic side effects compared to oral glucocorticoids, making them safe for long-term use in mild asthma management.

Key Points

• Inhaled corticosteroids are the most effective long-term control medication for asthma, improving symptoms, reducing exacerbations, and improving lung function 1.
• Low-dose ICS options are available for daily maintenance, including fluticasone propionate, budesonide, and beclomethasone.
• Proper inhaler technique is essential to prevent oral thrush and ensure effective treatment.
• ICS therapy is safe for long-term use in mild asthma management, with minimal systemic side effects compared to oral glucocorticoids.

Indications for Glucocorticoid Therapy

• Mild asthma: inhaled corticosteroids are the preferred therapy, used as needed or as daily maintenance.
• Moderate to severe asthma: oral systemic corticosteroids may be used to treat exacerbations, in addition to inhaled corticosteroids and other therapies 1.
• Exercise-induced bronchospasm: inhaled corticosteroids may be used as preventive treatment before exercise.

From the FDA Drug Label

1 INDICATIONS AND USAGE 1.1 Maintenance Treatment of Asthma

The indications for glucocorticoid (inflammatory steroid) therapy in mild asthma are for maintenance treatment of asthma, as stated in the drug label for budesonide (INH) 2.

• Maintenance treatment is the primary indication for glucocorticoid therapy in mild asthma.
• The label does not provide further specifics on the severity of asthma for which glucocorticoid therapy is indicated.

From the Research

Indications for Glucocorticoid Therapy in Mild Asthma

• The use of inhaled corticosteroids (ICS) is recommended for the treatment of mild asthma, as they provide effective anti-inflammatory therapy 3, 4.
• Low-dose ICS, such as fluticasone propionate, can provide significant improvements in lung function, reduce asthma symptoms, and prevent exacerbations in patients with mild asthma 4, 5.
• The combination of ICS and long-acting beta2-adrenergic (LABA) bronchodilators, such as salmeterol, can provide greater asthma control than ICS alone, and can reduce the frequency and severity of exacerbations 6, 7.
• The use of a combination product, such as Advair, which contains both fluticasone propionate and salmeterol, can provide convenient and effective treatment for mild asthma, and can improve patient adherence to treatment 7.

Dosage and Administration

• The recommended dosage of ICS for mild asthma is typically low, such as 100-250 microg of fluticasone propionate per day 4, 5.
• The dosage of ICS can be adjusted based on the patient's response to treatment, and the goal is to use the lowest effective dose to achieve asthma control 3.
• ICS can be administered once or twice daily, depending on the specific product and the patient's needs 3, 6.

Benefits of Glucocorticoid Therapy

• Glucocorticoid therapy can provide significant benefits for patients with mild asthma, including improved lung function, reduced asthma symptoms, and prevention of exacerbations 3, 4, 5.
• The use of ICS can also reduce airway inflammation and improve airway responsiveness in patients with mild asthma 5.
• The combination of ICS and LABA can provide greater benefits than ICS alone, and can improve overall asthma control 6, 7.