Inhaled Corticosteroids

Brand Names: Aerobid®, Azmacort®, Beclovent® Flovent®, Pulmicort®, Vanceril®
Generic Names: beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone

Inhaled corticosteroids are "controller" medicines taken two to four times a day. They are currently considered by doctors to be the "backbone" of modern asthma treatment. They are also widely misunderstood.

A Few Myths about Inhaled Corticosteroids
MYTH: They are the same thing as anabolic steroids . Some people are afraid to take their steroid inhalers because they associate them with the dangerous anabolic steroids that some athletes take illegally. In fact, these are two very different kinds of drugs, with entirely different effects.

MYTH: They have the same effects as oral corticosteroids . Some people associate steroid inhalers with taking similar medicine by mouth. They have experienced (or seen others experience) side effects like weight gain, "moon face," skin problems, and so forth. In fact, there are minimal side effects with inhaled corticosteroids because most of the action is right where it's needed, in the lungs. Very little of the medicine even gets to the rest of the body.

MYTH: They don't do anything. Many doctors have at one time or another heard a patient say, "I'm taking the albuterol, but I threw away the other inhaler you gave me because it didn't work." The fact is, inhaled corticosteroids take some time to kick in. It usually takes 2-3 weeks of daily use before you notice a difference. Then, however, most people report that their breathing is much improved.

How Inhaled Corticosteroids Work
Inhaled corticosteroids reduce inflammation in the airways. Inflammation is the major underlying cause of asthma symptoms.

As you deeply breathe the medicine in, it is pulled down into the lungs, where the medicine particles come to rest on the walls of the airways. The walls of the airways are inflamed in asthma, and the medicine goes to work right where it lands, relieving the swelling and excess mucus production. A small (usually insignificant) amount may also be absorbed into the blood stream.

The result is that with long-term use of inhaled corticosteroids, the airways get healthier and begin to be more like the airways of people without asthma. Air passes through the less swollen passages more easily, and the airway muscles also get less "twitchy" and aren't as prone to squeeze tightly at every little thing.

An important thing to keep in mind is that inhaled corticosteroids do not have any immediate effect. If you need to relieve symptoms now, use your rescue medicine!

How to Take Inhaled Corticosteroids
USE A SPACER! It is important when taking inhaled corticosteroids to get the medicine down into the lungs (and not just all sprayed on the tongue or the back of the throat). The best way to do this is to use a spacer with the inhaler. For illustrated instructions on using a spacer, go to Using your Metered Dose Inhaler and Spacer.

RINSE MOUTH AFTERWARDS. If residual medicine that lands on your tongue is allowed to stay there, it can cause problems in your mouth, such as thrush (an oral yeast infection). Rinsing your mouth with water after using your steroid inhaler prevents this.

TIME IT RIGHT. Inhaled corticosteroids are usually taken two to four times a day. If you take an inhaled bronchodilator (such as albuterol) on the same schedule, take the bronchodilator first, and wait a few minutes before taking the inhaled corticosteroid. It will open up your airways and help the inhaled steroid get farther into the lungs.

If you take your inhaled corticosteroid twice a day, you may want to take it first thing in the morning, and then again in the evening, so you can just keep the spacer at home and not have to take it with you to school or work.

Side Effects
The most common side effects from inhaled corticosteroids are thrush (oral yeast infection) and hoarseness. As mentioned above, rising the mouth with water can help prevent thrush. Hoarseness is a problem for about one in ten people on inhaled corticosteroids-talk to your doctor about trying a different kind of medicine if this is troublesome to you.

Most people experience no systemic side-effects from inhaled corticosteroids. At very high doses, however, there is theoretically a risk of metabolic effects similar to prednisone (though this has not been proven to occur).