Inhalation therapy respiratory corticosteroids

Infections Localized fungal infections with Candida albicans or Aspergillus niger have occurred in the mouth, pharynx, and occasionally in the larynx. The incidence of clinically apparent infection is low, and may require treatment with appropriate antifungal therapy or discontinuance of aerosol steroid treatment. Use inhaled corticosteroids with caution, if at all, in patients with active or quiescent tuberculous infection of the respiratory tract, untreated systemic fungal, bacterial, parasitic or... 

The toxin produced by B. anthracis is a major cause of the morbidity associated with the disease. One study suggested corticosteroids as adjunct therapy for inhalational anthrax associated with extensive edema, respiratory failure and meningitis (11,12). 

Routine modern therapy of severe exacerbations of asthma includes oxygen in addition to frequent inhalation of p -selective bronchodilators and. frequently, systemic corticosteroids. Therapy of status asthmaticus is more complicated, requiring intubation and respiratory assistance, sedation, parenteral corticosteroids, and bronchodilators. 

Modification of the pharmacokinetics through structural alterations has provided several new steroids with a better GR affinity and therapeutic index and a lower bioavailability than the older drugs (Fig. 33.14). The new inhaled/intranasal glucocorticosteroids like mometasone furoate, budesonide and fluticasone propionate are more lipophilic than those used in oral and systemic therapy and have greater affinity for the GR than does dexamethasone as a consequence of their greater lipophilicity (43). Several of the topical corticosteroids, such as mometasone furoate, BDP, triamcinolone acetonide, and flunisolide, were reintroduced as inhalation and intranasal dosage forms for treatment of respiratory diseases (e.g., asthma or rhinitis). Inhaled budesonide and flunisolide are readily absorbed from the airway mucosa into the blood and are rapidly biotransformed in the liver into inactive metabolites. Mometasone furoate and fluticasone propionate are very potent anti-inflammatory steroids with an oral bioavailability of less than 1%. Obviously, the risk of systemic side effects for these newer corticosteroids is greatly reduced when compared with ... 

Fungal Infections Although fxmgal upper respiratory tract colonisation and infections are known adverse effects of inhaled corticosteroids, only recently a fxmgal lower respiratory fracf infection, and more specifically a case of Candida pneumonia in a neonate, was attributed to ICS [11 ]. The neonate received inhaled beclomethasone therapy (400 xg, six times a day) for bronchopulmonary dysplasia. After 20 days of freafment, the patient developed a lower respiratory tract infection. Klebsiella pneumoniae was isolated in fhe fracheal aspirate and treated with amnxirillin-clavulanate without clinical improvement. A week later, bronchoscopy was performed and extended candidiasis was found and treated successfully with fluconazole. Candida pneumonia secondary to airway colonisation is rare and in this case, it was likely provoked by the ICS treatment. 

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