Inhaled corticosteroids

Inhaled corticosteroids (ICS) are the first-choice regular preventer therapy for adults and children with asthma.

They should be introduced for people who:

• Have had an asthma attack in the last two years
• Are using inhaled short-acting beta2 agonists three times a week or more
• Experience asthma symptoms three times a week or more
• Are waking one night a week due to their asthma symptoms.

Corticosteroids act to reduce inflammation and should be used on a regular basis to enable their protective effect to build up and reduce the risk of exacerbations. Alleviation of symptoms usually occurs three to seven days after initiation. Non-adherence to ICS is associated with increased risk of poor asthma control and should be continually monitored.

Doses of ICS are expressed as very low (generally paediatric dose), low (generally starting dose for adults), medium and high. Patients should be maintained on the lowest possible dose that provides adequate control. Reductions in inhaled corticosteroid dose should be considered every three months, decreasing the dose by approximately 25-50 per cent each time.

ICS used in the treatment of asthma include beclometasone, budesonide, ciclesonide, fluticasone and mometasone. All are similar in efficacy and adverse effect profile except Qvar and Clenil Modulite (beclometasone CFC-free brands), which should be prescribed by brand name, as they are not interchangeable. Qvar has extra-fine particles and is twice as potent as Clenil Modulite.

Side effects for inhaled corticosteroids remain low at recommended doses but prolonged use of high doses have been associated with adrenal suppression and growth restriction in children. All patients receiving high doses of steroids should receive a steroid card detailing their treatment.

Oral corticosteroids

prednisolone is the most widely used steroid for maintenance therapy in people with chronic asthma and doses should be kept at the lowest that provides adequate control. Short courses of prednisolone are also used for acute exacerbations