💊 Inhaled Corticosteroids

Inhaled corticosteroids (ICS) are anti-inflammatory medications delivered directly to the airways. They are the cornerstone of maintenance therapy for persistent asthma and play a role in COPD.

ICS work by reducing inflammation in the airways. They bind to intracellular glucocorticoid receptors, which then translocate to the nucleus to modulate gene expression. This leads to decreased synthesis of inflammatory mediators (e.g., cytokines, chemokines) and reduced activity of inflammatory cells (e.g., eosinophils, mast cells), thereby reducing airway hyperresponsiveness and swelling.

ICS are indicated as first-line maintenance therapy for persistent asthma of all severities to prevent symptoms and reduce exacerbations. They are also used in chronic obstructive pulmonary disease (COPD) in patients with frequent exacerbations or significant eosinophilic inflammation, often in combination with long-acting bronchodilators.

There are no absolute contraindications to ICS in the doses used for asthma or COPD, particularly in acute severe exacerbations where the benefits outweigh the risks. However, caution is advised in patients with active untreated tuberculosis or other untreated infections, as corticosteroids can suppress the immune response. Hypersensitivity to the drug is also a contraindication.

Common local side effects include oral candidiasis (thrush) and dysphonia (hoarseness), which can be minimised by rinsing the mouth after use. Systemic side effects are rare at standard doses but can include adrenal suppression, reduced bone mineral density, and cataracts with prolonged high-dose use. Cough and throat irritation are also common.

Patients should be monitored for symptom control, frequency of SABA use, and peak expiratory flow rates to assess asthma control. Regular assessment for oral candidiasis and proper inhaler technique is important. In children, growth should be monitored. Bone mineral density may be considered in patients on high doses long-term.

When prescribing, confirm any allergies. Counsel patients on the correct inhaler technique and the importance of rinsing their mouth with water and spitting it out after each dose to prevent oral thrush. Emphasise that ICS are 'preventer' medications and need to be taken regularly, even when feeling well, and are not for acute symptom relief.

ICS (e.g., beclometasone, fluticasone, budesonide) are the cornerstone of asthma management, reducing airway inflammation. They are 'preventer' medications, taken daily. Key side effects are local (oral thrush, hoarseness), mitigated by rinsing the mouth. Systemic effects are rare at usual doses. They are also used in some COPD patients.

SBAs frequently test ICS as the first-line 'preventer' for persistent asthma and their anti-inflammatory mechanism. Questions often focus on common local side effects like oral thrush and hoarseness, and how to mitigate them. The importance of rinsing the mouth after use is a common counselling point tested.