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Everything You Need to Know About Inhaled Corticosteroids
Inhaled corticosteroids are anti-inflammatory drugs that are prescribed to control asthma symptoms. Doctors also prescribe inhaled steroids to treat other types of lung disease, such as COPD (chronic obstructive pulmonary disease). Metered dose inhalers and nebulizers are the dosage forms that act locally on the airways to provide symptom relief while controlling the progress of the disease. Please continue reading to learn more about inhaled steroids and how to use them properly.
How do inhaled corticosteroids treat asthma symptoms?
Inhaled corticosteroids (also called inhaled steroids or inhaled glucocorticoids) are very effective in controlling asthma symptoms, even at very low doses. They are the first line of treatment for asthma, even with cases of persistent asthma in adults and children. Inhaled steroids reduce the number of inflammatory cells in the airways and control asthma by suppressing airway inflammation. Unlike rescue inhalers which are intended for rapid symptom relief, inhaled corticosteroids play a crucial role in long-term management. Compliance with the daily regimen of inhaled corticosteroids helps reduce the need for rescue inhalers and, in turn, prevents the harmful effects of poorly controlled asthma.
Doctors sometimes prescribe oral asthma medications in addition to inhaled corticosteroids for long-term asthma control. Examples of oral asthma medication include leukotriene modifiers such as montelukast (Singulair) and theophylline (Elixophyllin, Theochron). Instead of inhaled corticosteroids, combination inhalers containing a corticosteroid and a long-acting bronchodilator are effective alternatives for the long-term management of asthma. While the inhaled steroid works to reduce inflammation, the long-acting bronchodilator drug’s role is to relax the airway muscles and reduce shortness of breath and wheezing, the hallmark symptoms of asthma. Some examples of combination inhalers are Symbicort (budesonide-formoterol) or Advair HFA (fluticasone-salmeterol).
What are some examples of inhaled steroids?
Examples of inhaled steroids that may be prescribed to asthma patients include mometasone (Asmanex HFA, Asmanex Twisthaler), ciclesonide (Alvesco), fluticasone propionate (Flovent HFA), budesonide (Pulmicort Flexhaler), and beclomethasone (Qvar RediHaler). Steroid medicines like fluticasone propionate (Flonase) are also available in dosage forms such as nasal sprays to treat symptoms of allergic rhinitis.
Combination inhalers to improve asthma control contain an inhaled corticosteroid and long-acting bronchodilator. They are used to treat severe asthma. Examples of a combination inhaler include fluticasone/ salmeterol (Advair Diskus), budesonide/formoterol (Symbicort), mometasone/formoterol (Dulera), fluticasone/vilanterol (Breo Ellipta), fluticasone/umeclidinium/vilanterol (Trelegy Ellipta).
Note: Inhaled steroids do not stop an ongoing asthma attack. During a severe asthma attack, a short-acting bronchodilator (rescue inhaler) is used to control symptoms. This medicine relieves symptoms within 15 to 20 minutes, and its effects last for 4-6 hours. A rescue inhaler can also be used to prevent symptoms of exercise-induced asthma (breathing problems during exercise). Examples of short-acting bronchodilators include albuterol (Proair HFA, Ventolin HFA, Proventil HFA), levalbuterol (Xopenex HFA), and pirbuterol (Maxair Autohaler). Your healthcare professional may advise you to continue using your inhaled corticosteroid and long-acting bronchodilator exactly as prescribed, even after you use a rescue inhaler to treat a severe asthma attack.
What is the role of inhaled steroids in treating chronic obstructive pulmonary disease?
While inhaled steroids are very effective in controlling asthma symptoms and preventing asthma attacks, they are less effective in treating chronic obstructive pulmonary disease (COPD). However, your healthcare provider may prescribe inhaled steroids along with a bronchodilator if you have severe COPD. COPD patients treated with inhaled corticosteroids have fewer exacerbations or flares.
Can you take inhaled steroids long-term?
You can take inhaled steroids long-term for the maintenance treatment of asthma. Using inhaled steroids as prescribed helps to improve lung function, decrease mucus production, reduce the frequency of asthma attacks, and prevent irreversible damage to your airways. Inhaled steroids can be used to control asthma symptoms in patients of all ages and disease severity. These asthma medications help to improve the quality of life of people with asthma.
What are the major side effects of inhaled corticosteroids?
The major side effects of inhaled corticosteroids include:
Inhaled steroids can also cause long-term systemic side effects similar to an oral corticosteroid, such as bruising, osteoporosis (low bone density), glaucoma, cataracts, growth suppression, adrenal suppression, high blood sugar, and psychiatric problems such as mood swings and changes in behavior.
Why are patients instructed to rinse well after using a corticosteroid inhaler?
Patients are instructed to rinse their mouths with warm water after using a corticosteroid inhaler to prevent adverse effects like hoarseness, sore throat, and yeast infection. (Remember not to swallow the water after rinsing or gargling.) High doses of inhaled steroids are associated with an increased risk of these side effects. Your healthcare professional may advise you to use a spacer device to lessen the side effects of inhaled steroids.
What are the precautions for inhaled corticosteroids?
Dosing
Use the steroid reliever therapy exactly as prescribed by your healthcare provider. How many doses you need will depend on the severity of your asthma. Do not take higher or lower doses or use the inhaler more or less frequently than prescribed. Do not stop using inhaled steroids or combination inhalers without talking to your doctor first because it can cause increased asthma symptoms, leading to more frequent use of rescue inhalers.
Regular use
Remember that you need to use inhaled steroids every day at regular intervals for the medicines to work. It can take 4-6 weeks to notice a difference in your asthma symptoms and frequency of asthma attacks. The full benefits of these medications may not be seen for several months. However, you may get relief sooner if you are on other asthma medications, you may get relief sooner.
Oral corticosteroids are also available in table or liquid form. Oral steroids are typically used during acute asthma exacerbations. You should not stop using your inhaled corticosteroids if you are prescribed an oral steroid. Your doctor will give you instructions on how to gradually reduce the dose of oral steroids to avoid undesirable effects due to abrupt discontinuation.
Missed dose
If you miss a dose of your inhaled steroids, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at your regularly scheduled time. Do not take extra medicine to make up for a missed dose.
Administration
Inhaled steroids are available in various dosage forms, such as metered dose inhalers, dry powder inhalers, and nebulizing capsules for inhalation. Read the directions carefully and ask your healthcare provider to explain them if you do not understand. Show your healthcare provider how you use a metered dose inhaler or dry powder inhaler to ensure you do it correctly. Here are some tips on using inhaled steroids:
- Test or prime your inhaler before using it for the first time or using it after a long time. This involves shaking the inhaler well and spraying the medicine into the air once to ensure it delivers the correct dose.
- If you are using the open-mouth inhalation method, make sure you aim the inhaler into the center of your mouth so that the inhaled steroid does not hit your tongue or the roof of your mouth. A spacer device can make this easier.
- If you are using the closed-mouth method, you should not see a fine mist coming out from your nose or mouth. If you see a mist, you’re not using the inhaler correctly.
- Press the canister to release one puff of the medicine into your mouth. While doing this, breathe in slowly and count to 3-5 seconds. Do not breathe in through your nose. Hold your breath for up to 10 seconds after one inhalation.
- Don’t forget to clean your inhaler and spacer device at least once a week.
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