Corticosteroids
Corticosteroids are anti-inflammatory drugs available in inhaled and systemic forms for the short- and long-term control of asthma symptoms. Many products with differing potencies are available.
Inhaled corticosteroids include:

beclomethasone dipropionate
budesonide
flunisolide
fluticasone
triamcinolone acetonide.

Oral corticosteroids include:

prednisolone
prednisone.

I.V. corticosteroids include:

hydrocortisone sodium succinate
methylprednisolone sodium succinate.


Safe and sound
Corticosteroids
These special populations may require special care when taking corticosteroids:

Children: Growth should be monitored, especially when they’re taking systemic drugs or higher doses of inhaled drugs.
Elderly patients: May benefit from receiving drugs that prevent osteoporosis, such as alendronate during therapy with corticosteroids, especially if they’re taking higher doses of inhaled or systemic steroids.

Patients with diabetes: May require closer monitoring of their blood glucose levels while on steroids.
Breast-feeding women: Corticosteroid levels are negligible in the breast milk of mothers who take less than 20 mg/day of oral prednisone. The amount found in breast milk can be minimized if the woman waits at least 4 hours after taking prednisone to breast-feed her infant.

Pharmacokinetics
Oral prednisone is readily absorbed and extensively metabolized in the liver to the active metabolite prednisolone. The I.V. form has a rapid onset. Inhaled drugs are minimally absorbed, although absorption increases as the dosage is increased.

Pharmacodynamics
Corticosteroids work by inhibiting the production of cytokines, leukotrienes, and prostaglandins; the recruitment of eosinophils; and the release of other inflammatory mediators. They also affect other areas in the body, which can cause long-term adverse reactions.

Pharmacotherapeutics
Corticosteroids are the most effective drugs available for the long-term treatment and prevention of acute asthma attacks.

Inhalation for prevention
Inhaled corticosteroids are the preferred drugs for preventing future attacks in the patient with mild to severe asthma. Use of inhaled corticosteroids reduces the need for systemic steroids in many cases, thus reducing the patient’s risk of developing serious long-term adverse reactions.

Systemic for the serious
Systemic forms are usually reserved for moderate to severe attacks, but they’re also used in the patient with milder asthma that fails to respond to other measures. Systemic corticosteroids should be used at the lowest effective dosage and for the shortest period possible to avoid adverse reactions.

Drug interactions
Interactions are uncommon when using inhaled forms.

Hormonal contraceptives, ketoconazole, and macrolide antibiotics may increase the activity of corticosteroids in general, resulting in the need to decrease the steroid dosage.
Barbiturates, cholestyramine, rifampin, and phenytoin may decrease the effectiveness of corticosteroids, resulting in the need to increase the steroid dosage.

Warning!
Adverse reactions to inhaled corticosteroids
Adverse reactions to inhaled corticosteroids may include:

mouth irritation
oral candidiasis
upper respiratory tract infection.

To reduce the risk of adverse reactions from inhaled steroids, the patient should use the lowest possible dosage to maintain control, administer doses using a spacer, and rinse out his mouth after administration