Corticosteroids (inhaled)

Question 1

Suffix
Corticosteroids

Answer 1

“asone” or “sonide”

Question 2

Generic drug names
Corticosteroids

Answer 2

Beclometasone (inhaled)
Budesonide (inhaled)
Ciclesonide (inhaled)
Fluticasone furoate (inhaled)

Question 3

Indication
Corticosteroids

Answer 3

Maintenance treatment of asthma and COPD

Question 4

MOA
Corticosteroids

Answer 4

Reduce airway inflammation and bronchial hyper-reactivity.

Question 5

Precautions
Corticosteroids

Answer 5

COPD—inhaled corticosteroids may increase the risk of pneumonia.

Smoking—asthma patients who smoke may respond less well to inhaled corticosteroids than non-smokers and may require higher doses.

Question 6

Adverse effects
Corticosteroids

Answer 6

dysphonia, oropharyngeal candidiasis, bruising, facial skin irritation following nebulisation
Systemic adverse effects
Bone density loss
Pneumonia: risk may be increased in COPD patients.

Question 7

Counselling
Corticosteroids

Answer 7

Use spacer
rinse mouth with water after use

Question 8

Practice points
Corticosteroids

Answer 8

• check inhaler technique and compliance regularly
• inhaled corticosteroids may be a useful add-on treatment for COPD inadequately controlled with long-acting beta2 agonists

Question 9

Drug class and indication

Beclometasone (inhaled)

Answer 9

Corticosteroid
Maintenance treatment of asthma

Question 10

Drug class and indication

Beclometasone with formoterol

Answer 10

Corticosteroid + Beta2 agonist (LABA)
* Maintenance treatment of asthma (including additional symptom relief) when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with long-acting bronchodilators

Question 11

Drug class and indication

Beclometasone with formoterol and glycopyrronium

Answer 11

Corticosteroid + beta2 agonist (LABA) + anticholinergic (LAMA)
COPD with FEV1 <50% and recurrent exacerbations requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS)

Question 12

ICS aka…

Answer 12

Inhaled coricosteroid

Question 13

Drug class and indication

Budesonide (inhaled)

Answer 13

Corticosteroid
Maintenance treatment of asthma
Croup

Question 14

Drug class and indication

Budesonide with formoterol

Answer 14

ICS + LABA
* Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular budesonide and formoterol
* Maintenance and symptom relief of asthma
* Symptom relief (mild asthma)
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist

Inhaled corticosteroid + LABA beta2 agonist

Question 15

Drug class and indication

Budesonide with glycopyrronium and formoterol

Answer 15

ICS + LAMA + LABA
Moderate-to-severe COPD with frequent or severe exacerbations requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS)

Inhaled corticosteroid + LAMA Anticholinergic + LABA Beta2 agonist

Question 16

Drug class and indication

Ciclesonide (inhaled)

Answer 16

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

Question 17

Drug class and indication

Fluticasone furoate (inhaled)

Answer 17

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

Question 18

Drug class and indication

Fluticasone furoate with umeclidinium and vilanterol

Answer 18

ICS + LAMA + LABA
* Maintenance treatment of severe asthma inadequately controlled with a combination inhaled corticosteroid (ICS) and long-acting beta2 agonist (LABA)
* Moderate-to-severe COPD with frequent or severe exacerbations requiring treatment with a long-acting anticholinergic, a LABA and an ICS

Inhaled corticosteroid + inhaled anticholinergic + beta2 agonist

Question 19

Drug class and indication

Fluticasone furoate with vilanterol

Answer 19

ICS + LABA
* Maintenance treatment of asthma in patients who require a medium-to-high dose of inhaled corticosteroid (ICS) with a long-acting beta2 agonist (LABA)
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a LABA

Inhaled corticosteroid + Beta2 agonist

Question 20

Drug class and indication

Fluticasone propionate (inhaled)

Answer 20

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

Question 21

Drug class and indication

Fluticasone propionate with formoterol

Answer 21

ICS + LABA
Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular fluticasone propionate and formoterol

Inhaled corticosteroid + beta2 agonist

Question 22

Drug class and indication

Fluticasone propionate with salmeterol

Answer 22

ICS + LABA
* Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular fluticasone propionate and salmeterol
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist

Inhaled corticosteroid + beta 2 agonist

Question 23

Drug interactions
Corticosteroids

Answer 23

• metabolised by CYP3A4, consequently combinations with CYP3A4 inhibitors may increase their concentrations and the risk of adverse effects, while combinations with CYP3A4 inducers may decrease their efficacy.
• corticosteroids + NSAIDs
  Oral corticosteroids increase risk of gastric ulceration with NSAIDs; consider need for an NSAID carefully; if an NSAID cannot be avoided use lowest effective dose for shortest period of time