Inhaled Corticosteroids

MDI spacer

Inhaled β2-agonists and corticosteroids are frequently used together in the control of asthma. ICS may aid the effectiveness of bronchodilators. Inhaled medication must reach the small air passages in the lungs to be effective and this requires the correct use of the inhaler.

Current or previous smokers may have poor responses to ICS as steroids are prevented from switching off the inflammatory genes responsible for airway inflammation. Patients who smoke  may require higher doses of ICS compared with non-smokers for the same therapeutic effect. All smokers using an ICS should be offered help to stop smoking, as this may reduce the dose required by the patient and minimise the risk of side effects.

ICS must be used regularly for maximum benefit. Improvement in symptoms can usually be felt after 3-7 days. The lowest dose to achieve clinical benefit is best to avoid side effects. Doses can vary depending on how stable a patient is. If a patient is stable i.e. good asthma control with no exacerbations for 3 months, the dose of ICS can be reduced by 25-50%.

Before increasing dose of ICS, a patient’s adherence to treatment, inhaler technique and inhaler device (MDI + spacer) should be considered.

Patients who require prolonged high-dose ICS are at risk of systemic side effects, particularly immunosuppression and adrenal suppression, see side effects of steroids.

Side effects:

  • All patients using ICS should be advised to rinse their mouth with water and spit out and brush their teeth after inhaling steroids. This will reduce the likelihood of sore throat or hoarseness. If the patient notices white plaques in their mouth or on their throat, they should attend their GP as this could be oral thrush (candidiasis) which will need treatment with an antifungal drug.
  • A spacer device can be used with MDIs to reduce the amount of the drug which is deposited in the mouth and back of throat.
  • Dysphonia (difficulty speaking, hoarse voice).
  • Cough.
  • Pneumonia (COPD patients).