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Inhaled Corticosteroids in Lung Diseases.
Am J Respir Crit Care Med. 2013 Jan 31;
Authors: Raissy HH, Kelly HW, Harkins M, Szefler SJ
Abstract
Inhaled corticosteroids are used extensively in the treatment of asthma and chronic obstructive lung disease due to their demonstrated efficacy in reducing exacerbations and improving overall control. Their beneficial effect is based on their broad anti-inflammatory and immunosuppressive effects. The available inhaled corticosteroids vary in their therapeutic index based on individual drug potency, pharmacokinetics and specific delivery system. Although ICS are used in all age groups including children, younger and smaller children may be at a greater risk for adverse systemic effects as they can receive higher mg/kg doses of ICSs compared to older children. Most of the benefit from ICSs occurs in the low-medium dose range with minimal additional improvement with higher doses, although some patients may benefit from these higher doses. While ICS are the preferred agents for managing persistent asthma in all ages, their benefit in COPD is less convincing. When used appropriately, ICSs have few adverse events at low-medium doses but risk increases with high dose ICS. Although several new drugs are being developed and evaluated, it is unlikely that any of these new medications will replace ICS as the preferred initial long-term controller therapy for asthma but more effective initial controller therapy could be developed for COPD.
PMID: 23370915 [PubMed - as supplied by publisher]