Inhaled Steroids - Gold Standard of Asthma Treatment

(LifeWire) - Inhaled steroids, also known as inhaled corticosteroids or ICS for short, have become the mainstay of asthma treatment for persistent asthma in children and adults. These medications work in various ways on the immune system to prevent inflammation of the airways.

For patients with mild, moderate or severe chronic asthma, the first line of prevention is the use of daily ICS. These inhaled steroids come in different strengths and are generally used once or twice a day. Many brands of ICS are out there, including:

• Fluticasone (Flovent)
• Budesonide (Pulmicort)
• Triamcinolone (Azmacort)
• Flunisolide (Aerobid)
• Beclomethasone (Qvar)

Inhaled steroids have been found to improve symptoms and quality of life, while reducing acute asthma attacks, airway hyperreactivity, hospitalizations, ER visits and deaths. ICS have been shown to decrease the production of substances called cytokines, which are produced by immune cells to generate an inflammatory response. ICS have also been shown to cut down on the number of airway eosinophils -- a type of immune cell -- that tend to be active in allergic responses.

ICS are generally used as metered-dosed inhalers with a spacer. It is important to remember to rinse the mouth – and not swallow the rinse water – after using these inhalers. Rinsing will cut down on the amount of steroid that is absorbed into your body, as well as decrease the risk of developing thrush, a yeast infection of the mouth that can occur in people taking these inhaled steroids.

In general, inhaled steroids are well tolerated and have few side effects at the usual prescribed doses. Although, as with all medications, it is best to take the lowest dose that keeps the asthma under control.

If your symptoms have been well controlled for a while and you are not taking the lowest dose of ICS, you may want to consider asking your doctor about the possibility of cutting back. Many people with mild to moderate asthma are able to control their condition with low-dose ICS.

Doctors may also recommend a second inhaler or medication, such as a long-acting beta agonist, so that the first inhaled steroid dose may be reduced. This second inhaler or added medication is sometimes referred to as a "steroid sparing" drug.

Long-term use of oral steroids has been shown to cause many side effects, including glaucoma, cataracts, osteoporosis, bruising and slowed growth in children. There has been concern that long-term use of inhaled steroids could cause these problems as well. However, research indicates that there are limited side effects at average doses. But these effects do increase at high doses, which is why your doctor will try to control your asthma with the lowest possible dose of inhaled steroids.

Anyone taking inhaled steroids who also has a family history of glaucoma should have regular eye exams. Children who take ICS should have their growth closely monitored. Women using ICS should take supplemental calcium and vitamin D and speak with their doctor to determine when it is appropriate to have bone scan screenings performed. ICS are recommended therapy for continued asthma control during pregnancy. The ICS medication, Budesonide (Pulmicort) has been studied more than other ICS in pregnant women, but all ICS are considered safe for use.

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