Corticosteroids

Question 1

What are the inhaled cortico steroids (ICS)

Answer 1

“SONE’s”
Beclometasone
Mometasone
Fluticasone
Budesonide
Ciclesonide

Question 2

What are the indications and Moa for its ICS

Answer 2

MOA-works long term to reduce airway inflammation (Used ‘as maintenance therapy ]
Indication- maintenance therapy for ASTHMA and COPD

Question 3

What are the precautions for ICS

Answer 3

COPD- when used can increase risk of pneumonia as it suppressed the immune system
Smoking- may respond less that non smokers hence may need a higher dose

Question 4

ICS in pregnancy and breastfeeding

Answer 4

Pregnancy- pt are recommended to use ICS
Beclometasone, Budesonide or Fluticasone propionate are prefereed
NB.- Fluticasone furoate vs Fluticasone proprionate- One is ONCE daily and other TWICE daily
Fluticasone furoate is 5 times more potent and thus only needed to be used ONCE daily - maybe beneficial for patients with poor compliacnce

Question 5

What ARE the adverse effects OF INHALED ICS

Answer 5

COMMON-Thrush( oral pharyngeal candidiasis)
SYSTEMIC ADVERSE EFFECTS -
BMD- long term inhaled HIGH dose cortico steroids ( greater than 6months usage) can contribute to decreased BMD It decreases osteoblast function and decreases calcium absorption
—teriparide drug given to steroid induced osteoporosis as it helps increase osteoclast formation—
Adrenal suppression- can occur when cease steroid use from a dose abruptly- consider tapering down dose
Impaired growth- higher doses in kids can impair growth
Glaucoma/cataract- increased risk
Pneumonia- increased for copd patients

Question 6

What is the dosage requirement and councelling/practice points for ICS

Answer 6

Start with lower dose or maybe medium dose before increasing to higher dose
Use with a spacer to get maximum dosage to the lungs with out loss in mouth and to prevent systemic symptoms
Rinse mouth and spit water out after each usage