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Corticosteroids in the Treatment of Asthma

Practical Recommendations

  • Practical Therapeutics
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Summary

Asthma treatment is currently undergoing transition as recognition of the important role of anti-inflammatory therapy continues. Asthma is now recognised as a chronic inflammatory process that can be modulated by anti-inflammatory agents. The effectiveness of systemic therapy with corticosteroids has been known for decades, and aerosolised forms of corticosteroids are playing an increasingly important role in treating and preventing asthma. The early introduction of inhaled corticosteroids, along with avoidance of causal factors, may prevent or reduce progression and chronicity of this disease.

The most recent guidelines, including the International Consensus, emphasise the early use of anti-inflammatory agents, including inhaled corticosteroids as first line therapy. Currently, inhaled corticosteroids are indicated for adults and children with moderate to severe asthma. Because of the variability of asthma, treatment with inhaled corticosteroids must always be titrated individually to the lowest dosage that is adequate to maintain optimal asthma control. It must also be recognised that long term use of high dosage therapy, i.e. 2 or 3 times the conventional dosage, may offer optimal efficacy for patients with more severe asthma.

Numerous studies have established the safety of inhaled corticosteroids. The risk of local and systemic adverse effects is relatively small. Furthermore, the second generation inhaled corticosteroids, such as budesonide and fluticasone, have high topical to systemic potency ratios, offering greater anti-inflammatory actions while decreasing systemic adverse effects.

We recommend that inhaled corticosteroids be considered in all patients with asthma, except for those with mild or only occasional symptoms. The importance of proper follow-up and comprehensive patient education should not be overlooked, since treatment failures can often be attributed to poor patient compliance or incorrect use of inhalers. Studies in the future will continue to address the important question of whether treating the inflammatory component of asthma will improve long term prognosis, and if delaying treatment promotes disease progression. Currently, clinical trials have firmly established that therapy with inhaled corticosteroids is effective, reducing the severity of the inflammatory process, and free from significant adverse effects.

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  1. Division of Allergy and Clinical Immunology, Department of Medicine, University of Wisconsin-Madison School of Medicine, Madison, Wisconsin, USA

    Kelly A. McGill, Bina Joseph &  William W. Busse

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McGill, K.A., Joseph, B. & Busse, W.W. Corticosteroids in the Treatment of Asthma. Clin Immunother 4, 16–48 (1995). https://doi.org/10.1007/BF03259069

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