Used both for treatment and prophylactic purposes.
Mechanism of action
They are presumed to act by their broad anti inflammatory efficacy mediated in part by inhibition of production of inflammatory mediators. They also potentiate the effects of b- receptor agonists and inhibit the lymphocytic-eosinophilic airway mucosal inflammation.
Effects on airway
- decreases bronchial reactivity
- increases airway caliber
- decreases frequency of asthma exacerbation and severity of symptoms
The corticosteroids commonly used are hydrocortisone, predinisolone, beclomethasone, triamcinolone and etc.
The drugs can be taken by inhalation as aerosol, oral, or an IV administration Because of severe adverse effects when given chronically, oral and parenteral corticosteroids are reserved for patient who need urgent treatment and those who have not improved with bronchodilator. Aerosol treatment is the most effective way to decrease the systemic adverse effect of corticosteroid therapy. Abrupt discontinuation should be discouraged because of the fear of adrenal insufficiency. Doses should be decreased after improvement. Regular or controlled therapy is better maintained with aerosol corticosteroids.
Clinical uses in bronchial asthma
- Urgent treatment of severe asthma not improved with bronchodilator
- IV, inhalation or oral.
- Nocturnal asthma prevention
- oral or inhalation
- Chronic asthma
- Regular aerosol corticosteroids
Side effects:
- Suppression of the hypothalamic-pituitary-adrenal axis
- Osteoporosis
- Sodium retention and hypertension
- Cataract
- Impairment of growth in children
- Susceptibility to infection like oral candidiasis, tuberculosis
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