What are the available inhaled corticosteroids (ICS) for asthma management?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 7, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Steroid inhalers available for asthma include fluticasone (Flovent, Arnuity Ellipta), budesonide (Pulmicort), beclomethasone (QVAR), mometasone (Asmanex), ciclesonide (Alvesco), and triamcinolone (Azmacort), which are the most effective long-term control medications for persistent asthma, as established by strong evidence 1. These medications are also available in combination with long-acting beta-agonists, such as fluticasone-salmeterol (Advair), budesonide-formoterol (Symbicort), mometasone-formoterol (Dulera), and fluticasone-vilanterol (Breo Ellipta). Some key points to consider when using steroid inhalers include:

  • Typical dosing ranges from once to twice daily depending on the specific medication and severity of asthma
  • Rinsing the mouth after use to prevent oral thrush, a fungal infection
  • Consistent daily use is essential even when feeling well, as these medications may take several days to weeks to reach full effectiveness
  • Side effects are generally minimal with inhaled steroids compared to oral steroids, but may include hoarseness, throat irritation, and oral thrush
  • Long-acting beta-agonists are not to be used as monotherapy for long-term control of asthma, but can be used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma 1.

In terms of specific medications, the following are available:

  • Fluticasone (Flovent, Arnuity Ellipta)
  • Budesonide (Pulmicort)
  • Beclomethasone (QVAR)
  • Mometasone (Asmanex)
  • Ciclesonide (Alvesco)
  • Triamcinolone (Azmacort)
  • Combination medications, such as fluticasone-salmeterol (Advair), budesonide-formoterol (Symbicort), mometasone-formoterol (Dulera), and fluticasone-vilanterol (Breo Ellipta) It's worth noting that there are no clinically meaningful differences among the various types of inhaled corticosteroids, and the choice of medication should be based on individual patient needs and preferences, as well as the specific characteristics of the medication, such as dosing frequency and potential side effects 1.

From the FDA Drug Label

Budesonide inhalation suspension is an inhaled corticosteroid indicated for: Maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age ASMANEX TWISTHALER is an inhaled corticosteroid (ICS) prescription medicine used as maintenance treatment for the prevention and control of asthma symptoms in people 4 years of age and older. ALVESCO is an inhaled corticosteroid indicated for maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 12 years of age and older.

The list of steroid inhalers available for asthma includes:

  • Budesonide (INH) 2
  • Mometasone (INH) 3
  • Ciclesonide (INH) 4

From the Research

Available Steroid Inhalers for Asthma

The following steroid inhalers are available for asthma treatment:

  • Fluticasone propionate (FP) 5, 6
  • Beclomethasone dipropionate (BDP) 5, 6
  • Budesonide (BUD) 5, 6
  • Ciclesonide (CIC) 7

Comparison of Steroid Inhalers

Studies have compared the efficacy and safety of these steroid inhalers:

  • Fluticasone propionate (FP) has been compared to Beclomethasone dipropionate (BDP) and Budesonide (BUD) in several studies, with FP showing small improvements in measures of airway calibre 5, 6
  • Ciclesonide (CIC) has been compared to Budesonide (BUD) and Fluticasone propionate (FP), with no significant difference in lung function, symptoms, quality of life, airway responsiveness, or inflammatory markers 7

Key Findings

Key findings from the studies include:

  • Fluticasone propionate (FP) given at half the daily dose of Beclomethasone dipropionate (BDP) or Budesonide (BUD) leads to small improvements in measures of airway calibre, but may have a higher risk of causing sore throat and hoarseness 5, 6
  • Ciclesonide (CIC) may have similar effectiveness and efficacy to Fluticasone propionate (FP) and Budesonide (BUD), but the evidence is limited to small, phase II studies 7

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What is the preferred treatment for a 14-year-old patient with a history of episodic wheezing, currently using albuterol (short-acting beta-agonist) as needed, who experiences nighttime wheezing and has required urgent care visits and short courses of oral corticosteroids?
What is the algorithm for managing asthma?
What are the alternatives to albuterol (salbutamol)?
What is the most likely indicated treatment for an 18-year-old female with a dry cough, occasional small amounts of white sputum, no fever, normal vital signs, clear lungs, and a normal chest X-ray, with occasional wheezes?
How can the therapy of a 58-year-old male with Chronic Obstructive Pulmonary Disease (COPD) using a combination (combo) medication and inhaler once daily be optimized?
What are the implications of a stable examination with evidence of degenerative disc disease at the L3-L4 (Lumbar 3-4) and L5-S1 (Lumbar 5-Sacrum 1) levels?
Can spironolactone be used to treat Hypertension (HTN)?
Can tissue plasminogen activator (tPA) be administered for myocardial infarction (MI) more than 12 hours after onset?
Should a patient with atherosclerotic heart disease continue taking Plavix (clopidogrel)?
Can anti-androgen (hormone) treatments, specifically androgen deprivation therapy (ADT), for prostate cancer cause penile retraction?
What is the treatment for Tinea cruris (jock itch) in a 10-year-old child?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question