Respiratory/Inhaled corticosteroid (ICS)

Inhaled corticosteroids

also: beclometasone · budesonide · fluticasone · preventer · brown inhaler

Overview

The anti-inflammatory "preventer" — the backbone of asthma control. As ICS/formoterol it is now also the reliever (AIR/MART).

Mechanism

Topical glucocorticoid in the airway → suppresses eosinophilic/inflammatory mediators → ↓airway hyper-reactivity and exacerbations. Low systemic absorption with correct technique.

Indications

Asthma (anti-inflammatory control — within AIR/MART)
COPD (only with asthmatic/steroid-responsive features or eosinophilia)

The agents

Beclometasone / budesonideICS

Budesonide/formoterol is the AIR/MART combination.

FluticasoneICS

potent

In several combination inhalers.

Adverse effects

Oral candidiasis / dysphoniaclassic

Rinse mouth + use a spacer to prevent.

Growth velocity reduction in childrencommon

Monitor height; use lowest effective dose.

Adrenal suppression / systemic effects (high dose)common

Cautions & contraindications

Untreated airway infectionall

Interactions

Potent CYP3A4 inhibitors (ritonavir) → systemic steroid effects

Monitoring & kinetics

Inhaler technique, height in children, asthma control

Inhaled regularly (preventer) or as the ICS component of an ICS/formoterol reliever.

Source: NICE NG245 — Asthma · BNF — Corticosteroids (inhaled)