Respiratory - Corticosteroids (glucocorticoids), inhaled: beclometasone, budesonide, fluticasone

Question 1

Corticosteroids (glucocorticoids), inhaled: beclometasone, budesonide, fluticasone

Indications

Answer 1

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.

Question 2

Corticosteroids (glucocorticoids), inhaled: beclometasone, budesonide, fluticasone

Mechanism of Action

Answer 2

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.