Corticosteroids for asthma

In patients who require chronic systemic corticosteroids for asthma control, the lowest possible dose should be used. Toxicities may be decreased by alternate-day therapy or high-dose inhaled corticosteroids. 

WUliams DM. Clinical considerations in the use of inhaled corticosteroids for asthma. Pharmacotherapy 2001 21 38S 8S. 

Yiallouros PK, Milner AD, Conway E, Honour JW. Adrenal function and high dose inhaled corticosteroids for asthma. Arch Dis Child 1997 76 405-10. 

Quak W, Klok T, Kaptein AA, Duiverman EJ, Brand PL. Preschool children with high adherence to inhaled corticosteroids for asthma do not show behavioural problems. Acta Paediatr November 2012 101(ll) 1156-60. 

Corticosteroids are the most efficacious treatment available for the long-term treatment of asthma, and inhaled corticosteroids are considered to be a first-line therapy for asthma (247). In the early 1950s, cortisone (31) and cortisol (29) were used to treat asthma. However, dmgs with fewer side effects and with... 

There are few definitive data to substantiate the efficacy of LTRA therapy in refractory asthma, except for patients with aspirin-sensitive asthma. This is a fairly uncommon form of asthma that occurs generally in adults who often have no prior (i.e., childhood) history of asthma or atopy, may have nasal polyposis, and who often are dependent upon oral corticosteroids for control of their asthma. This syndrome is not specific to aspirin but is provoked by any inhibitors of the cycloxygenase-1 (COX-1) pathway. These patients have been shown to have a genetic defect that causes... 

Maintenance and prophylactic treatment of asthma for asthma patients who require systemic corticosteroid administration when adding an inhaled corticosteroid may reduce or eliminate the need for systemic corticosteroids... 

Up to 80% of asthmatics have symptoms of rhinitis, and inflammation of the upper airways may increase AHR.1,3 Treatment of rhinitis with intranasal corticosteroids may improve asthma symptoms and is recommended for asthma patients with rhinitis. 

Corticosteroids are the most potent anti-inflammatory agents available for the treatment of asthma. The efficacy of corticosteroids is due to their ability to affect multiple inflammatory pathways, resulting in the suppression of inflammatory cell activation and function, prevention of microvascular leakage, decreased mucus production, and upregulation of P2-adrenergic receptors.10,18 Clinically, corticosteroids decrease airway inflammation, decrease AHR, decrease mucus production and secretion, and improve the response to P2-agonists.18 Corticosteroids for the treatment of asthma are available in inhaled, oral, and injectable dosage forms. 

Leukotriene modifiers either inhibit 5-lipoxygenase (zileuton) or competitively antagonize the effects of leukotriene D4 (montelukast and zafirlukast). These agents improve FEV, and decrease asthma symptoms, rescue drug use, and exacerbations due to asthma. Although these agents offer the convenience of oral therapy for asthma, they are significantly less effective than low doses of inhaled corticosteroids.2,33... 

Cromolyn and nedocromil are inhaled anti-inflammatory agents that block both the early- and late-phase response. Both agents are considered alternative therapies to inhaled corticosteroids for the treatment of mild persistent asthma however, both are less effective than low doses of inhaled corticosteroids.2,30 The exact mechanism of action of these agents is not understood, but they appear to inhibit mast cell mediator release as well as modulate other inflammatory responses.3... 

Theophylline is also considered an alternative to inhaled corticosteroids for the treatment of mild persistent asthma however, limited efficacy compared to inhaled corticosteroids, a narrow therapeutic index with life-threatening toxicity, and multiple clinically important drug interactions have severely limited its use. Theophylline causes bronchodilation through inhibition of phosphodiesterase and antagonism of adenosine and appears to have anti-inflammatory and immunomodulatory properties as well.36... 

The first commercially available DPI system appeared on the market in 1949, developed and marketed by Abbott under the name Aerohaler. Like all early pulmonary drug-delivery devices, it delivered small-molecule compoimds (bronchodilators or inhaled corticosteroids) to the airways (not necessarily the deep limg) for the treatment of asthma or chronic obstructive pulmonary disease. Table 6 lists some of the early DPI systems used for asthma and COPD the energy somces in these devices were mechanical and patient inspiration. 

LTB4 is a potent bronchoconstrictor, as are several other leukotrienes. A 5-lip-oxygenase inhibitor, Zileuton, is approved for therapy of asthma (though it is not much used for this purpose) as is a leukotriene blocker, montelukast, marketed as Singulair. Singulair is widely used by asthmatics as a preventive for asthma attacks. Certain corticosteroids are employed for the same purpose. Neither montelukast nor the steroids are effective in terminating an established asthmatic attack. Beta agonists are employed for that purpose (see chapter 17). 

The majority of the marketed products are used for asthma and COPD. Typical agents that are used for these indications are fl2-agonists such as salbutamol (albuterol), Terbutalin or formoterol, corticosteroids such as budesonide, FUxotide or beclomethasone and mast-cell stabilizers such as sodium cromoglycate or nedocromil. 

Corticosteroids do not heal illnesses, but they are widely used in various conditions when it is necessary to utilize their anti-inflammatory, immunosuppressant, and mineralo-corticoid properties. In addition, they are used in replacement therapy for patients who have adrenal insufficiency. Corticosteroids can be used in vital situations for asthma, severe allergic reactions, and transplant rejections. They are effective in noninfectious granulomatous diseases such as sarcoidosis, collagen vascular disease, rheumatoid arthritis, and leukemia. Steroids are used as lotions, ointments, etc. in treating a number of dermatological and ophthalmologic diseases. 

Recommended Starting Doses of Fluticasone Propionate/Salmeterol for Asthma Patients (Age 12) Taking Inhaled Corticosteroids ... 

Guilbert TW, Morgan WJ, Zeiger RS, Manger DT, Boehmer SJ, Szefler SJ et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med 2006 354 1985-97. 

Boushey HA, Sorkness CA, King TS, Sulivan SD, Eahy JV, Lazarus SC et al. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 2005 352 1519-28. 

Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalised patients. Cochrane Database Syst Rev 2001. 

Rowe BH, Spooner CH, Ducharme EM, Bretzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev 2001. 

Shaw RJ. Inhaled corticosteroids for adult asthma impact of formulation and delivery device on relative pharmacokinetics, efficacy and safety. Respir Med 1999 93 149-60. 

Besides corticosteroids, other drugs with various modes of action are being marketed or developed for asthma and other respiratory disorders. 

Patients receiving salmeterol for asthma should normally also be receiving regular and adequate doses of an effective asthma controller medication, such as inhaled corticosteroid... 

The British Thoracic and Tuberculosis Association. Inhaled corticosteroids compared with oral prednisone in patients starting long-term corticosteroid therapy for asthma. Lancet 1975 2(7933) 469-73. 

Hip osteonecrosis secondary to the administration of corticosteroids for feigned bronchial asthma. The clinical spectrum of the factitious disorders. Arthritis Rheum 1994 37(1) 139—41. 

Bennett ML, Fountain JM, McCarty MA, Sherertz EF. Contact allergy to corticosteroids in patients using inhaled or intranasal corticosteroids for allergic rhinitis or asthma. Am J Contact Dermat 2001 12(4) 193-6. 

Chronotherapies that have been employed for asthma include oral corticosteroids, theophylline and / 2-adrenergic agonists [10]. 

In 1987 the xanthine derivative theophylline was the most commonly used medication in the treatment of asthma, followed by / 2-agonists, such as albuterol or ter-butaline, and inhaled corticosteroids, for example budesonide or flunisolide. Today, the most frequently used medication is inhaled / 2-agonists and it is expected that these therapy patterns have shifted toward greater use of inhaled corticosteroids [4, 5], Nevertheless, whether used alone or in combination with other therapies, corticosteroids do not consistently abrogate airway inflammation in patients with asthma common side effects associated with this type of drug are increased heart rate, nervousness, tremors, nasal irritation, nausea, and headaches [8, 10, 11],... 

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