Corticosteroids

Corticosteroids are used for the management of reversible and irreversible airways disease. An inhaled corticosteroid used for 3–4 weeks may help to distinguish asthma from chronic obstructive pulmonary disease; clear improvement over 3–4 weeks suggests asthma. Corticosteroids are effective in asthma; they reduce airway inflammation (and hence reduce oedema and secretion of mucus into the airway). An inhaled corticosteroid is used regularly for prophylaxis of asthma when patients require a beta2 agonist more than twice a week, or if symptoms disturb sleep more than once a week, or if the patient has suffered exacerbations in the last 2 years requiring a systemic corticosteroidor a nebulised bronchodilator. Regular use of inhaled corticosteroids reduces the risk of exacerbation of asthma.

Inhaled Corticosteroids 

Budesonide:

Indications: Asthma Prevention, Bronchial Asthma. Severe Chronic Obstructive Pulmonary Disease

Contraindications: Acutely Deteriorating Asthma, Status Asthmaticus. Acute Tuberculosis, Fungal Infection of Lung, Fungal Infections, Ocular Herpes Simplex, Parasitic Infection, Uncontrolled Bacterial Infections.

Dose and Administration: By inhalation of powder, adult and child over 12 years, 100–800 micrograms twice daily, adjusted as necessary; alternatively, in mild to moderate asthma, 200–400 micrograms (max. 800 micrograms if stabilised on equivalent daily dose given in divided doses) as a single dose each evening; child 6–12 years, 100–400 micrograms twice daily; alternatively, in mild to moderate asthma, 200–400 micrograms as a single dose each evening. By inhalation of nebulised suspension, when starting treatment, during periods of severe asthma, and while reducing or discontinuing oral corticosteroids, 1–2 mg twice daily (may be increased further in very severe asthma); child 3 months–12 years, 0.5–1 mg twice daily.

Maintenance, usually half above doses.

Croup , 2 mg as a single dose (or as two 1-mg doses separated by 30 minutes).

Fluticasone:

Indications: Asthma Prevention, Bronchial Asthma, And Severe Chronic Obstructive Pulmonary Disease

Contraindications: Acute Asthma Attack, Status Asthmaticus, Acute Tuberculosis, Fungal Infections, Ocular Herpes Simplex, Parasitic Infection, And Uncontrolled Bacterial Infections

Dose and Administration: By aerosol inhalation, adult and child over 16 years, 100–250 micrograms twice daily, increased according to severity of asthma to 1 mg twice daily; child 4–16 years, 50–100 micrograms twice daily adjusted as necessary; max. 200 micrograms twice daily. By inhalation of nebulised suspension, adult and child over 16 years, 0.5–2 mg twice daily; child 4–16 years, 1 mg twice daily.

Ciclesonide:

Indications: Asthma Prevention, Bronchial Asthma, And Severe Chronic Obstructive Pulmonary Disease.

Contraindications: Acute Asthma Attack, Status Asthmaticus, Acute Tuberculosis, Fungal Infections, Inactive Tuberculosis, Ocular Herpes Simplex, Oropharyngeal Candidiasis, Parasitic Infection, Uncontrolled Bacterial Infections. Dose and Administration: By aerosol inhalation, adult and child over 12 years, 160 micrograms daily as a single dose reduced to 80 micrograms daily if control maintained.

Compound Preparations

Budesonide & Formeterol:

Indications: Bronchial Asthma, Chronic Obstructive Pulmonary Disease, COPD Associated with Chronic Bronchitis, and Prevention of Bronchospasms with Emphysema

Contraindications: Acutely Deteriorating Asthma, Status Asthmaticus, Acute Tuberculosis, Chronic Coronary Insufficiency, Conduction Disorder of the Heart, Fungal Infection of Lung, Fungal Infections, Hypokalemia, Ocular Herpes Simplex, Parasitic Infection, Seizure Disorder, Thyrotoxicosis, Uncontrolled Bacterial Infections

Dose and Administration: By inhalation of powder, asthma maintenance therapy, 1 puff twice daily increased if necessary to max. 2 puffs twice daily, reduced to 1 puff once daily if control maintained; child 12–17 years 1 puff twice daily reduced to 1 puff once daily if control maintained.

Fluticasone & Salmeterol:

Indications: Bronchial Asthma, Chronic Obstructive Pulmonary Disease.

Contraindications: Acute Asthma Attack, Acutely Deteriorating Asthma, and Status Asthmaticus. Acute Tuberculosis, Chronic Coronary Insufficiency, Conduction Disorder of the Heart, Fungal Infections, Ocular Herpes Simplex, Parasitic Infection, Uncontrolled Bacterial Infections.

Dose and Administration: By aerosol inhalation, asthma, adult and child over 4 years, 2 puffs twice daily, reduced to 2 puffs once daily if control maintained.