Corticosteroids

Question 1

Give example of Corticosteroids?

Answer 1

Inhaled

• Beclometasone
• Budesonide
• Fluticasone

Oral

• Prednisolone
• Dexamethasone

Question 2

What are the indications of Corticosteroids?

Answer 2

Inhaled corticosteroids

• Regular prevention of asthma
• Maintenance therapy in COPD in combination with long acting bronchodilator if FEV1 <50% (note that some patients with COPD do not have steroid reversibility)
• Hayfever (intra-nasal use)

Oral corticosteroids

• Treatment of acute exacerbation of asthma
• Long term low dose maintenance therapy in asthma
• Treatment of acute exacerbation of COPD (COPD Guidance)
• Long term low dose maintenance therapy in COPD (rarely indicated)
• Bronchospasm or partial obstruction
• Dyspnoea in palliation

Question 3

What are the contraidictions of Corticosteroids?

Answer 3

Caution

• Pregnancy
• Breast feeding (inhaled corticosteroid unlikely to be significantly present in breast milk

Question 4

How Corticosteroids work (mechanism of Corticosteroids)?

Answer 4

Corticosteroids act in asthma and COPD to reduce the inflammatory response in the airways.

Corticosteroids have an anti-inflammatory effect in many tissues. Virtually all cells contain steroid receptors which then bind to DNA to prevent or induce gene expression.

In the context of inflammation, corticosteroids:

• Decrease neutrophil and macrophage recruitment and action
• Decrease fibroblast formation
• Decrease osteoblast and increase osteoclast activity
• Decrease production of prostanoids
• Decrease production of cytokines
• Decrease histamine release
• Decrease IgG production

This reduces oedema and mucus production in the airways as well as inhibiting allergic reactions.

Question 5

Administration of Corticosteroids?

Answer 5

Inhalation

• Aerosol: Taken as required, via an MDI (metered dose inhaler) or a dry powder device +/- a spacer device. Note: there are a number of dry powder formulations available.
• Intranasal

Oral

Intravenous (severe exacerbations only)

**********The MHRA has recommended that beclomethasone dipropionate inhalers (Qvar, Clenil Modulite) be prescribed by brand as they are not interchangeable with other beclomethasone based inhalers*******