Inhaled corticosteroids

Question 1

Give the 2 common clinical indications for the use of inhaled corticosteroids.

Answer 1

1) Asthma: to treat airway inflammation and control symptoms at step 2 of the asthma management pathway when a short acting beta 2 agonist is not adequate.
2) COPD: patients with severe airflow obstruction on spirometry or recurrent exacerbations; usually prescribed in conjunction with a LABA or a LAMA.

Question 2

Describe the mechanism of action of inhaled corticosteroids.

Answer 2

Corticosteroid passes through plasma membranes > interacts with receptors > receptor passes into nucleus > gene transcription modification > pro-inflammatory interleukins, cytokines and chemokine down regulated > anti-inflammatory proteins unregulated.

Question 3

Describe the overall effects of inhaled corticosteroids.

Answer 3

1) Reduce mucosal inflammation
2) Widen airways
3) Reduce mucous secretion.

Question 4

Give the 2 main local adverse effects of inhaled corticosteroids.

Answer 4

Oral candidiasis and a hoarse voice.

Question 5

1) What might ICS increase the risk of in patients with COPD?
2) Name 3 potential systemic effects of ICS when used in high doses.

Answer 5

1) Pneumonia.

2) Adrenal suppression, growth retardation and osteoporosis.

Question 6

1) In what groups of patients should Fluticasone be used with caution in?
2) What are the adverse drug reactions of ICSs?

Answer 6

1) COPD patients with a Hx of pneumonia and children when there is the potential for growth suppression.
2) None.

Question 7

Why might brand name prescribing be necessary when prescribing ICS treatment?

Answer 7

Because different brands may use different preparations of the same drug. Different preparations may have different potencies depending upon how they are deposited in the airway.

Question 8

What can poorly controlled airway inflammation in asthma lead to?

Answer 8

Airway remodelling and fixed airflow obstruction.

Question 9

What is the main difference between the use of ICSs in asthma and in COPD.

Answer 9

In asthma, ICSs control symptoms and prevent disease progression. In COPD, ICSs reduce exacerbations but do not slow down disease progression.

Question 10

Name 2 inhaled corticosteroid drugs.

Answer 10

Beclometasone and Fluticasone.