From the Guidelines
Inhaled corticosteroids are the preferred treatment for persistent asthma, as they improve asthma control more effectively than any other single long-term control medication. The use of inhaled corticosteroids has been consistently shown to reduce airway inflammation, prevent symptoms, and improve quality of life for patients with asthma 1. Common inhaled corticosteroids include fluticasone, budesonide, beclomethasone, mometasone, and ciclesonide, which are typically prescribed at low to medium doses for mild to moderate asthma.
Some key points to consider when using inhaled corticosteroids for asthma management include:
- They should be taken daily on a long-term basis to achieve and maintain control of symptoms
- Combining inhaled corticosteroids with long-acting beta agonists is effective and safe when inhaled corticosteroids alone are insufficient
- Inhaled corticosteroids have been shown to be more effective than other long-term control medications, such as cromolyn, nedocromil, theophylline, or leukotriene receptor antagonists, in improving asthma outcomes 1
- It is essential to rinse the mouth after using an inhaled corticosteroid to prevent oral thrush, a common side effect
Overall, the use of inhaled corticosteroids is a crucial component of asthma management, and their effectiveness in improving asthma control and reducing morbidity and mortality makes them a cornerstone treatment for persistent asthma.
From the FDA Drug Label
In clinical trials with fluticasone propionate inhalation powder using dosages up to and including 250 mcg twice daily, occasional abnormal short cosyntropin tests (peak serum cortisol < 18 mcg/dL assessed by radioimmunoassay) were noted both in subjects receiving fluticasone propionate and in subjects receiving placebo. The incidence of abnormal tests at 500 mcg twice daily was greater than placebo In a 2-year trial carried out with a dry powder inhaler in 64 subjects with mild, persistent asthma (mean FEV1 91% of predicted) randomized to fluticasone propionate 500 mcg twice daily or placebo, no subject receiving fluticasone propionate had an abnormal response to 6-hour cosyntropin infusion (peak serum cortisol < 18 mcg/dL)
Asthma inhaler with steroids:
- The drug label mentions the use of fluticasone propionate inhalation powder for asthma.
- The label notes that in clinical trials, occasional abnormal short cosyntropin tests were noted in subjects receiving fluticasone propionate.
- The incidence of abnormal tests was greater at higher dosages (500 mcg twice daily) compared to placebo.
- A 2-year trial in subjects with mild, persistent asthma found no abnormal responses to cosyntropin infusion in subjects receiving fluticasone propionate 500 mcg twice daily 2.
From the Research
Asthma Inhaler with Steroids
- Asthma inhalers with steroids, also known as inhaled corticosteroids (ICSs), are a common treatment option for asthma 3, 4, 5, 6.
- ICSs are recommended for patients with persistent asthma and can help reduce morbidity and mortality from asthma 4, 5.
- There are different types of ICSs available, including fluticasone propionate, budesonide, and beclometasone, each with its own potency and efficacy 3, 5, 6.
- Studies have shown that fluticasone propionate is a potent ICS that can improve lung function and symptom control in patients with asthma 3, 6.
- Combination therapies, such as fluticasone/salmeterol and budesonide/formoterol, can be more effective than monotherapies in improving treatment outcomes 3.
- However, long-term use of high-dose ICS therapy can cause systemic side effects, such as impaired growth in children, decreased bone mineral density, and cataracts 4.
- To minimize these risks, it is recommended to use the lowest effective dose of ICS and to monitor patients regularly for signs of systemic side effects 4, 7.
- Step-down therapy, where the dose of ICS is reduced or the treatment is gradually withdrawn, may be recommended for adult patients with asthma who have been well-controlled with moderate or high-dose ICSs for more than 12 weeks 7.