An Inhaled Corticosteroid is a type of medication that is often administered by Respiratory Therapists. In order to deliver this medication to a patient, it’s important to first understand exactly how it works.

Hopefully, this study guide can make the learning process easier for you. It has practice questions for your benefit as well. So if you’re ready, let’s get started.

What are Inhaled Corticosteroids?

Inhaled Corticosteroids are a type of medication that is often used to treat patients with Asthma and COPD. Glucocorticoids are lipid-soluble drugs that provide anti-inflammatory effects on the airways.

They are considered to be maintenance or controller medications because they work by decreasing inflammation seen in obstructive diseases. With that said, they are not to be used during an acute attack or exacerbation because they do not provide immediate relief.

List of Examples of Inhaled Corticosteroids:

Here is a list of some of the most common examples of inhaled corticosteroids:

  • Budesonide (Pulmicort)
  • Beclomethasone (QVAR)
  • Fluticasone propionate (Flovent)
  • Ciclesonide (Alvesco)
  • Flunisolide hemihydrate (AeroSpan)
  • Fluticasone furoate (Arnuity Ellipta)
  • Mometasone furoate (Asmanex)

In the list, the generic name was provided first, followed by the brand name. Keep in mind that other inhaled corticosteroids may exist. These are just a few of the most common examples.

What are Inhaled Corticosteroids (List for Asthma and COPD)

Side Effects of Inhaled Corticosteroids:

Here is a list of some of the most common side effects that may occur when inhaled corticosteroids are administered:

  • Cough
  • Sore throat
  • Difficulty speaking
  • Bronchoconstriction
  • Oral fungal infection (thrust)

Keep in mind that other side effects may occur. These are just a few of the most common examples.

Why is Mouth Rinsing Important with Inhaled Corticosteroids?

Oral thrush is a fungal infection that can occur in the mouth after an inhaled corticosteroid has been given. It can be avoided simply by rinsing out the mouth with water after use.

As a Respiratory Therapist, it’s important to instruct a patient to always rinse out their mouth after using an inhaled corticosteroid medication.

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Inhaled Corticosteroids Practice Questions:

1. What are corticosteroids used for?
They are used for the maintenance and control of chronic asthma.

2. What other disease is corticosteroid drugs used to treat?
COPD

3. What are intranasal aerosol agents used for?
They are used for seasonal and perennial allergic/non-allergic rhinitis.

4. What are the three adrenal cortical hormones?
Glucocorticosteroids, mineral corticoids, and sex hormones.

5. What is the onset and peak for inhaled steroids that are used for maintenance?
12 hours for the onset and 24 hours for the peak effects.

6. What disease response shows an increased FEV1 greater than 12%?
An asthmatic response.

7. An FEV1 of greater than what shows that an asthmatic episode is susiding?
80% predicted.

8. How much energy is used in normal breathing?
5%.

9. When the hypothalamus and pituitary glands are inhibited, this is known as?
HPA/Adrenal Suppression.

10. What does Endogenous mean?
The body makes it within.

11. What is the diurnal steroid cycle also known as?
Circadian rhythm.

12. What are three signs of inflammation?
Redness, flare, and wheal.

13. What is the alternate day steroid therapy?
Mimics natural diurnal rhythm by giving steroid drug early in the morning when normal tissue levels are high.

14. What does increased vascular permeability cause?
Leaky capillary syndrome.

15. What is it called when white cells emigrate through capillary walls (diapedesis) in response to attractant chemicals (chemotaxis)?
Leukocytic infiltration.

16. What is it known as when white cells and macrophages in the lungs ingest and process foreign material such as bacteria?
Phagocytosis.

17. What is a mediator cascade?
Histamine and chemoattractant factors are released at injury site.

18. What are the most common diseases affected by inflammation of the airway?
Chronic bronchitis and asthma.

19. Why are treatments with anti-inflammatory agents such as glucocorticoids important?
Reduces airway hyperresponsiveness and predisposition to acute episodes of obstruction.

20. In asthma, what comes first, inflammation or bronchoconstriction?
Inflammation.

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21. What combination corticosteroids are most common?
Fluticasone propionate/salmeterol (Advair).

22. What is a risk of intranasal corticosteroid use?
Increased risk of Infection.

23. What are intranasal corticosteroids used for?
Treatment of allergic or inflammatory nasal conditions and seasonal and perennial allergic/nonallergic rhinitis.

24. What three effects do corticosteroids have on WBC’s?
Demargination: depletion of neutrophil stores reduces their accumulation at inflammatory sites and in exudates; overall increases in white cell count; and, constriction of microvasculature to reduce leakage of cells and fluids into inflammatory sites.

25. What effects do steroids have on beta receptors?
Makes them more responsive to beta agonist.

26. When are aerosol steroids used in asthma?
In early use or during acute severe asthma.

27. When are aerosol steroids used in COPD?
They are used to relieve symptoms or when there is little or no effect on the FEV1.

28. What does endogenous mean?
Produced inside the body.

29. What does exogenous mean?
From outside and manufactured to be placed inside the body.

30. What are adrenal cortical hormones?
Chemicals secreted by the adrenal cortex (steroids).

31. What is the correct pathway sequence for the hypothalamic-pituitary-adrenal (HPA) axis regulation of corticosteroid secretion?
Stimulation of hypothalamus > Release of CRF > Release of corticotropin > Secretion of glucocorticoids.

32. What corticosteroids are delivered via oral inhalation?
Ciclesonide (Alvesco) and Budesonide (Pulmicort).

33. What cells mediate inflammation in the airway?
Eosinophils, neutrophils, and macrophages.

34. What is true regarding alternate-day steroid therapy?
Alternate-day therapy mimics the natural diurnal rhythm by giving a steroid drug early in the morning, when normal tissue levels are high.

35. What is a synthetic trifluorinated glucocorticoid with high topical anti-inflammatory potency?
Flunisolide (AeroSpan).

36. What should the respiratory therapist do prior to administering inhaled corticosteroid therapy?
Evaluate pulse before treatment, evaluate the breathing rate and pattern, and evaluate the breath sounds by auscultation.

37. What is the site of secretion of epinephrine?
Adrenal medulla.

38. What hormone regulates body water by increasing the amount of sodium reabsorption in the renal tubules?
Mineralocorticoids.

39. What side effects are seen in the systemic administration of corticosteroids?
Hypertension, cataract formation, and immunosuppression.

40. What are corticosteroids normally secreted by?
Adrenal cortex.

41. What are some clinical indicators for intranasal aerosol steroids?
Seasonal allergies and perennial allergies.

42. What is the description of corticosteroids?
Anti-inflammatory agents.

43. What occurs during an asthma attack?
Bronchospasm, mucosal edema, and increased secretions.

44. What drugs are found in fluticasone propionate and salmeterol?
Advair HFA.

45. What are general symptoms of inflammation?
Redness, swelling, heat, and pain.

46. What are the major effector cells of the inflammatory response regardless of the type of asthma, allergic, or non-allergic?
Mast cell and eosinophil.

47. What are the side effects of aerosol administration of corticosteroids?
They result in minimal side effects.

48. What minimizes local side effects associated with the use of inhaled corticosteroids?
Spacer, rinsing mouth, and low dose.

49. What is recommended to avoid complicating side effects seen with systemic treatment with steroids?
Switch to aerosol administration.

50. What is caused by an early asthmatic response?
Eosinophils.

51. What are some common side effects of inhaled steroids?
Oral thrush and dysphonia.

52. What is Symbicort?
A combination of budesonide and formoterol.

53. What is the indication if a drug such as flunisolide shows a peak plasma level quickly within 2 minutes?
Good absorption by the lungs.

54. What drugs are Mometasone and formoterol found in?
Dulera.

55. What is one of the primary reasons for using aerosolized glucocorticoids?
To minimize adrenal suppression.

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56. What can be suggested to a patient who has severe asthma that has been prescribed corticosteroids for her treatment and wants to know which type of corticosteroid should be used that will have minimal adverse effects?
Inhaled corticosteroids.

57. What is one advantage of using ciclesonide over other inhalation steroids?
Decreases the development of Candida albicans in the mouth.

58. What is the best way to monitor changes in peak expiratory flow rate in a person with asthma taking inhaled steroids?
Use a peak flow meter.

59. What is recommended in order to prevent the need to increase inhaled corticosteroid use in a person who is currently receiving low dose inhaled steroids?
Long-acting B2 agonist.

60. What are the causes of airway inflammation?
Trauma: Direct (gunshot, stabbing) and indirect (baseball bat, steering wheel); chronic bronchitis (respiratory and systemic infections); asthma (allergic stimulation); and, inhalation of toxic or noxious substances.

61. What are the major cells responsible for an inflammatory response in asthma?
Mast cells eosinophils (The early phase of an asthmatic reaction occurs during 15 minutes to 1 hour); androgenic corticosteroids (testosterone and estrogen); and, the sex hormones (testosterone) responsible for secondary male sex characteristics (corticotropin-releasing factor (CRF) is produced by the hypothalamus).

62. What is a significant side effect of corticosteroid use?
Inhibition of HPA axis.

63. What can the use of oral steroids for long periods cause?
HPA suppression.

64. Can patients with adrenal suppression be abruptly withdrawn from oral corticosteroids and placed on an aerosol dosage?
No, the aerosol should be started while the oral drug is slowly tapered off.

65. What rhythm do the rise and fall of glucocorticoids in the body follow?
A diurnal or circadian rhythm.

66. What is the problem if a patient has no signs or symptoms of an infection and still has an elevated white blood cell (WBC) count?
Glucocorticoids are being taken, which is the most likely cause of the increased WBC.

67. What are the beneficial effects of glucocorticoids on β-adrenergic receptors?
Restoration of responsiveness to β-adrenergic stimulation enhances β-receptor stimulation by increasing the number and availability of β-receptors on cell surfaces and increasing the affinity of the receptor for β-agonists.

68. What can be suggested if a patient is having chest tightness and wheezing four to six times a week and using Albuterol MDI with relief?
Suggest a corticosteroid like Beclomethasone MDI to reduce inflammation.

69. What are the primary inflammatory cells in COPD?
Neutrophils.

70. What are the common side effects of inhaled corticosteroids?
Oropharyngeal fungal infections like candidiasis (oral thrush); dysphonia (Hoarseness and changes in voice quality); and, pharyngeal irritation.

71. What can be suggested if a patient is using a corticosteroid via MDI and complaining of oral thrush and hoarseness?
Using an antistatic valve holding chamber/spacer and rinsing the mouth after use.

72. What are the side effects of systemic steroid treatments?
Suppression of the HPA axis, psychiatric reactions, fluid retention and increased WBC count.

73. What dosage forms of corticosteroids are available for use in the United States?
DPI, MDI, and nebulizer solution.

74. What do glucocorticosteroids do medically?
They reduce the proliferation, migration, adhesion, activation, and survival of inflammatory leucocytes; reduce edema at the inflammatory site and impair fibrosis and wound healing.

75. What is the (exhaled nasal nitric oxide) upper limit for adults?
35 ppb.

76. What is the generic name of QVAR?
Beclomethasone, dipropionate, and HFA.

77. What is the generic name of AeroSpan?
Flunisolide hemihydrate HFA.

78. What is the generic name of Flovent HFA?
Fluticasone propionate.

79. What is the generic name of Pulmicort?
Budesonide.

80. What is the generic name for Asmanex HFA?
Mometasone furoate.

81. What is the generic name of Advair HFA?
Fluticasone propionate/salmeterol.

82. What is the generic name of Symbicort?
Budesonide/formoterol fumarate HFA.

83. What is the generic name of Dulera?
Mometasone furoate/formoterol fumarate HFA (the product combining an inhaled steroid and a bronchodilator is Dulera).

84. What are the two most common inflammatory lung diseases?
Asthma and chronic bronchitis.

85. What does inflammation produce?
Redness: local dilation of blood vessels, occurring in seconds; flare: reddish color several centimeters from the site, occurring 15-30 seconds after injury; and, wheal: local swelling, occurring in minutes.

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86. What are the causes of airway inflammation?
Trauma: Direct (gunshot, stabbing) and indirect (baseball bat, steering wheel); Chronic Bronchitis: Respiratory and systemic infections; asthma: allergic stimulation; and, inhalation of toxic or noxious substances.

87. What are the major cells responsible for an inflammatory response?
Mast cells and eosinophils.

88. What is the early asthmatic response?
The early phase of an asthmatic reaction occurs during 15 minutes to 1 hour.

89. What are the four symptoms that, in an acute state, the asthmatic patient will exhibit?
Wheezing, breathlessness, chest tightness and cough.

90. What are the three types of corticosteroid hormones produced by the adrenal cortex?
Glucocorticoids (cortisol), mineralocorticoids (aldosterone); androgenic corticosteroids (testosterone and estrogen) and the sex hormones (testosterone) responsible for secondary male sex characteristics.

91. What is the corticotropin-releasing factor (CRF) produced by?
Hypothalamus.

92. What is caused by the use of oral steroids for long periods?
HPA suppression

93. What must be done with patients with adrenal suppression who cannot be abruptly withdrawn from oral corticosteroids and placed on an aerosol dosage?
The aerosol should be started while the oral drug is slowly tapering off.

94. What do glucocorticoids exert?
An anti-inflammatory effect in the body.

95. What are the side effects of glucocorticoids?
Muscle wasting and steroid diabetes.

96. What is the primary reason for using aerosolized glucocorticoids versus systemic ones?
To minimize HPA suppression via a smaller dose.

97. How must one withdraw an adrenally suppressed patient from oral corticosteroid treatment?
The oral agent is tapered off slowly while the aerosolized corticosteroids are started.

98. When is cortisol levels the highest?
In the morning at 8 am (night shift work can interfere with the cycle).

99. How do corticosteroids act?
The act as though they are preparing the body for a period of starvation and dehydration by mobilizing energy stores into glucose and glycogen (glucocorticoids) and conserving water by reducing urine production (mineralocorticoids).

100. What should a patient always do after using an inhaled corticosteroid?
They should always rinse out their mouth and spit in order to prevent oral thrush.

Final Thoughts

So there you have it. Hopefully, you now have a better understanding of inhaled corticosteroid medications and how they can be used to treat patients with asthma and COPD.

We have a similar guide that covers the most important Anti-Infective Agents that I think will benefit you as well. Thank you so much for reading and as always, breathe easy my friend.

References

The following are the sources that were used while doing research for this article:

  • Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019 [Link].
  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020 [Link].
  • Liang, Tian. “Inhaled Corticosteroids – StatPearls – NCBI Bookshelf.” NCBI Bookshelf, 10 Feb. 2020, www.ncbi.nlm.nih.gov/books/NBK470556.

Disclosure: The links to the textbooks are affiliate links which means, at no additional cost to you, we will earn a commission if you click through and make a purchase.