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Allergy and Asthma pp 873–907Cite as

Inhaled Corticosteroid Therapy for Asthma

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Abstract

Inhaled Corticosteroids (ICS) play a significant role in the management of asthma and are the preferred medication for mild, moderate and severe persistent asthma by current asthma management guidelines. Currently, seven ICS are approved for asthma control and maintenance by the United States Food and Drug Administration (U.S. FDA): Beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone furoate, fluticasone propionate, and mometasone furoate, with all approved for children under 12 years of age except mometasone furoate and ciclesonide. ICS are effective in improving all asthma outcomes, as demonstrated through multiple rigorous clinical trials. ICS efficacy is dependent upon many factors including but not limited to: pharmacogenetics and pharmacogenomics, ICS delivery device, patient technique and adherence, and ICS pharmacokinetics and pharmacodynamics.

Systemic side effects of ICS are dose-related. Therefore, the lowest effective dose should always be used. Many well-designed studies have examined the effects of FDA-approved ICS doses on HPA axis and growth, but fewer studies with less robust designs have examined their effects on bone mineral density, cataracts, and glaucoma. FDA-approved doses of most ICS suppress the growth of children. FDA-approved doses in highly-susceptible individuals or higher-than-approved doses in any individual can suppress the HPA axis sub-clinically or clinically and produce life threatening adrenal crisis. Even considering the unexpected growth effect from FDA-approved ICS doses, benefits outweigh risks at FDA-approved ICS doses for most individuals as long as monitoring for systemic side effects is frequent, regular, and accurate. In contrast, benefits may not outweigh risks for those with very mild disease who have the least to gain and most to lose from ICS therapy, or in those using higher-than-approved ICS doses, in which cases even higher levels of monitoring may be warranted.

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Authors and Affiliations

  1. School of Pharmacy, Duquesne University, Pittsburgh, PA, USA

    Jennifer Padden Elliott & Nicole Sossong

  2. Pediatric Alliance, LLC, Pittsburgh, PA, USA

    Deborah Gentile

  3. School of Medicine, West Virginia University, Morgantown, WV, USA

    Kacie M. Kidd & David P. Skoner

  4. Ortho Eyes, McMurray, PA, USA

    Christina E. Conte & Jonathan D. Skoner

  5. Pediatric & Adult Vision Care, Wexford, PA, USA

    Jonathan D. Skoner

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  1. Jennifer Padden Elliott
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Correspondence to David P. Skoner .

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  1. Division of Allergy & Immunology, University of South Florida, Tampa, FL, USA

    Dennis K. Ledford

  2. Milton S Hershey Med Ctr, Penn State University, Hershey, PA, USA

    Timothy Craig

  3. Department of Medicine and Pediatrics, Penn State College of Medicine, Hershey, PA, USA

    Timothy Craig

  4. Division of Allergy & Immunology, Dept. of Internal Medicine, University of South Florida Morsani College of Medicine, James A Haley Veterans' Hospital, Asthma and Immunology Associates of Tampa Bay, Tampa, Florida, USA

    Dennis K. Ledford

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Elliott, J.P. et al. (2019). Inhaled Corticosteroid Therapy for Asthma. In: Allergy and Asthma. Springer, Cham. https://doi.org/10.1007/978-3-030-05147-1_39

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