Inhaled corticosteroids are essential for treating various respiratory conditions, offering powerful anti-inflammatory effects directly to the lungs. They help manage chronic respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD) by reducing airway inflammation, swelling, and mucus buildup.
For millions of individuals worldwide, inhaled corticosteroids provide long-term control of symptoms, minimizing the risk of flare-ups and improving overall lung function.
This article explores how inhaled corticosteroids work, their benefits, potential side effects, and key considerations for effective use.
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What are Inhaled Corticosteroids?
Inhaled corticosteroids are medications used to reduce inflammation in the airways, making them essential for managing respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). They work by suppressing the immune response that causes swelling and mucus production, helping to open airways and improve breathing.
Common inhaled corticosteroid medications include budesonide, fluticasone, and beclomethasone. They are typically administered through inhalers or nebulizers, delivering the medicine directly to the lungs with minimal systemic side effects.
Regular use helps prevent asthma attacks and control chronic symptoms, though they are not suitable for immediate relief during acute breathing emergencies.
Side Effects
While inhaled corticosteroids are generally safe and well-tolerated, some patients may experience side effects due to the medication’s localized action in the respiratory tract.
Common side effects include:
- Cough: Often triggered by inhaler irritation or improper inhaler technique.
- Sore Throat: Due to medication residue irritating the throat lining.
- Hoarseness or Difficulty Speaking: Caused by vocal cord irritation.
- Bronchoconstriction: A paradoxical reaction where the airways temporarily narrow after inhalation.
- Oral Fungal Infections (Thrush): A yeast infection in the mouth caused by residual medication, especially with improper inhaler use.
To minimize side effects, patients are advised to use a spacer device with MDIs, rinse their mouths after inhaler use, and maintain proper inhaler technique.
Inhaled corticosteroids should not be used for acute asthma attacks or COPD exacerbations, as they are intended for long-term inflammation control rather than immediate symptom relief. Regular consultations with healthcare providers ensure safe and effective treatment management.
Types of Inhaled Corticosteroids
Inhaled corticosteroids come in various formulations tailored for managing respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).
These medications are typically delivered through metered-dose inhalers (MDIs), dry powder inhalers (DPIs), or nebulizers, depending on the patient’s needs and severity of their condition.
Some of the most commonly prescribed ICS include:
- Budesonide (Pulmicort): Often used with nebulizers, especially in pediatric asthma management.
- Beclomethasone (QVAR): Known for its effectiveness in controlling persistent asthma symptoms.
- Fluticasone Propionate (Flovent): A widely used inhaler offering various dosing options.
- Ciclesonide (Alvesco): A prodrug activated in the lungs, reducing systemic side effects.
- Flunisolide Hemihydrate (AeroSpan): Offers built-in spacers for easier administration.
- Fluticasone Furoate (Arnuity Ellipta): A long-acting formulation for once-daily use.
- Mometasone Furoate (Asmanex): Effective in reducing airway inflammation with once- or twice-daily dosing.
Note: The appropriate type, dosage, and administration frequency depend on the patient’s specific respiratory condition, age, and treatment goals as determined by their healthcare provider.
Mouth Rinsing After the Use of Inhaled Corticosteroids
Mouth rinsing after using inhaled corticosteroids is an essential practice to reduce the risk of side effects such as oral thrush (a fungal infection) and sore throat.
After inhaling the medication, patients should rinse their mouths thoroughly with water and spit it out—without swallowing. This helps remove any residual corticosteroid particles that may settle in the mouth or throat, where they could cause irritation or infection.
Using a spacer device with metered-dose inhalers further minimizes medication deposition in the mouth, enhancing drug delivery to the lungs. Consistent mouth rinsing supports better oral health while ensuring effective respiratory treatment.
Inhaled Corticosteroid Practice Questions
1. What are corticosteroids used for?
Corticosteroids are used for the maintenance and control of chronic asthma by reducing airway inflammation.
2. What other disease are corticosteroid drugs used to treat?
Chronic obstructive pulmonary disease (COPD)
3. What are intranasal aerosol agents used for?
They are used to treat seasonal and perennial allergic/non-allergic rhinitis.
4. What are the three adrenal cortical hormones?
Glucocorticosteroids, mineralocorticoids, and sex hormones.
5. What is the onset and peak for inhaled steroids used for maintenance?
Onset: 12 hours; Peak effects: 24 hours.
6. What disease response shows an increased FEV1 greater than 12%?
An asthmatic response indicates improved airflow.
7. An FEV1 of greater than what shows that an asthmatic episode is subsiding?
Greater than 80% predicted.
8. How much energy is used in normal breathing?
About 5% of total body energy.
9. When the hypothalamus and pituitary glands are inhibited, what is this known as?
Hypothalamic-Pituitary-Adrenal (HPA) suppression or adrenal suppression.
10. What does endogenous mean?
It means that the body produces it internally.
11. What is the diurnal steroid cycle also known as?
The circadian rhythm.
12. What are three signs of inflammation?
Redness, flare, and wheal.
13. What is alternate-day steroid therapy?
It mimics the body’s natural diurnal rhythm by administering steroids early in the morning when tissue cortisol levels are naturally high.
14. What does increased vascular permeability cause?
Leaky capillary syndrome, leading to fluid leakage into tissues.
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?
The release of histamine and chemoattractant factors at the injury site, triggering an inflammatory response.
18. What are the most common diseases affected by airway inflammation?
Chronic bronchitis and asthma.
19. Why are treatments with anti-inflammatory agents such as glucocorticoids important?
They reduce airway hyperresponsiveness, inflammation, and the risk of acute obstructive episodes.
20. In asthma, what comes first: inflammation or bronchoconstriction?
Inflammation occurs first, leading to bronchoconstriction.
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21. What combination corticosteroids are most common?
Fluticasone propionate/salmeterol (Advair).
22. What is a risk of intranasal corticosteroid use?
An increased risk of infection due to immune suppression.
23. What are intranasal corticosteroids used for?
They treat allergic or inflammatory nasal conditions, including seasonal and perennial allergic/nonallergic rhinitis.
24. What three effects do corticosteroids have on white blood cells (WBCs)?
Demargination: Depletion of neutrophil stores reduces accumulation at inflammation sites; Increased WBC Count: Elevated white cell count due to reduced migration; and Microvascular Constriction: Reduces leakage of cells and fluids into inflammatory tissues.
25. What effects do steroids have on beta receptors?
Steroids make beta receptors more responsive to beta-agonists, enhancing bronchodilation.
26. When are aerosol steroids used in asthma?
Aerosol steroids are used during the early stages of asthma management or during acute severe asthma episodes.
27. When are aerosol steroids used in COPD?
They are used to relieve symptoms, especially when there is little or no improvement in FEV1 with bronchodilators.
28. What does endogenous mean?
Produced naturally within the body.
29. What does exogenous mean?
Originating from outside the body and introduced into the body.
30. What are adrenal cortical hormones?
Steroids secreted by the adrenal cortex, including glucocorticoids, mineralocorticoids, and androgens.
31. What is the correct pathway sequence for the hypothalamic-pituitary-adrenal (HPA) axis regulation of corticosteroid secretion?
Stimulation of the hypothalamus > Release of Corticotropin-Releasing Factor (CRF) > Release of corticotropin (ACTH) > Secretion of glucocorticoids from the adrenal cortex.
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 administering steroids early in the morning when tissue cortisol levels are naturally 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 the patient’s pulse, respiratory rate, breathing pattern, and breath sounds through auscu