Steroids in respiratory disease

Inhaled steroids may be used in the longterm treatment of asthma and, occasionally, chronic obstructive pulmonary disease (chronic bronchitis and emphysema) (1).

In asthma, airway inflammation is present even in mild disease, and therapy with inhaled glucocorticoids is now recommended at a much earlier stage than previously.

• according to a number of clinical trials and studies, inhaled corticosteroids reduce hospitalization rates and death rates due to asthma (2)

Extensive studies have demonstrated that inhaled steroids, irrespective of the preparation, have minimal systemic effects when used at low doses. Systemic side effects may occur at high doses - above 400 microgrammes of beclomethasone per day in children and 800 microgrammes of beclomethasone in adults (3).

The amount of systemic absorption can be reduced by the use of spacer devices with metered-dose inhalers and by mouth rinsing after the use of dry-powder inhalers. These should be used whenever doses of 800 microgrammes of beclomethasone per day (or equivalent) or more are needed to control asthma.

Smoking (both current and ex-smokers) decreases the effect of inhaled steroids and higher doses may be needed in these patients (4).

Reference:

• (1) MHRA. Inhaled products that contain corticosteroids. Drug Safety Update;2008:1(12),6-7
• (2) Barnes NC. The properties of inhaled corticosteroids: similarities and differences. Prim Care Respir J. 2007;16(3):149-54
• (3) Regional Drug and Therapeutics Center (RDTC) 2008. Safer medication use. Inhaled corticosteroids
• (4) Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (BTS) 2009. British guideline on the management of asthma: a national clinical guideline (revised 2009)