Corticosteroids (glucocorticoids) Flashcards
What are the respiratory indications?
Asthma: to treat airways inflammation and control symptoms at ‘step 2’ of therapy where asthma is not adequately controlled by a short-acting β2-agonist alone.
Chronic obstructive pulmonary disease (COPD): to control symptoms and prevent exacerbations in patients who have severe airflow obstruction on spirometry and/or recurrent exacerbations. Inhaled corticosteroids are usually prescribed in combination with a long-acting β2-agonist and/or a long-acting antimuscarinic bronchodilator.
What is the mechanism of actions?
Corticosteroids pass through the plasma membrane and interact with receptors in the cytoplasm. The activated receptor then passes into the nucleus to modify the transcription of a large number of genes. Pro-inflammatory interleukins, cytokines and chemokines are downregulated, while anti-inflammatory proteins are upregulated. In the airways, this reduces mucosal inflammation, widens the airways, and reduces mucus secretion. This improves symptoms and reduces exacerbations in asthma and COPD.
Give examples of corticosteroids used in respiratory conditions.
Beclometasone
Budesonide
Fluticasone
What are the side effects?
The main adverse effects of inhaled corticosteroids occur locally in the airway, where their immunosuppressive effect can cause oral candidiasis (thrush infection). They can also cause a hoarse voice. In COPD, there is some evidence they may increase the risk of pneumonia.
Very little is absorbed into the blood, so there are few systemic adverse effects unless taken at very high dose when systemic side effects including adrenal suppression, growth retardation (children) and osteoporosis may occur.
What are the contra-indications?
High-dose inhaled corticosteroids, particularly fluticasone, should be used with caution in COPD patients with a history of pneumonia and in children, where there is potential for growth suppression.
Interactions?
Do not generally apply to inhaled corticosteroids.
How are corticosteroids eliminated?
Irrespective of the route of administration (injection, oral or inhalation), BDP and its metabolites are mainly excreted in the feces. Less than 10% of the drug and its metabolites are excreted in the urine.
Patient information?
Explain that you are offering a steroid inhaler to ‘dampen down’ inflammation in the lung. Reassure them that hardly any of the steroid is absorbed into the body so, except in very high-dose treatment, there are unlikely to be any serious side effects (or weight gain). Advise them to rinse their mouth and gargle after taking the inhaler to prevent development of a sore mouth or hoarse voice. Show your patient how to use the device and check and correct their technique as necessary every time you see them.
