Inhaled corticosteroids

Inhaled corticosteroids enter airway cells and bind the glucocorticoid receptor, which moves to the nucleus and changes gene expression: anti-inflammatory proteins rise and cytokines and other mediators fall, so fewer mast cells, eosinophils and lymphocytes inflame the airway. Benefit builds over days to weeks, not at once. Inhaled, they act strongly where they land with little whole-body effect.

• BeclometasoneA prodrug activated by hydrolysis; in one inhaler with formoterol it can serve as both preventer and reliever in asthma.
• BudesonideBeyond inhalers it comes as capsules for Crohn's disease affecting the ileum or ascending colon; heavy first-pass breakdown limits how much reaches the rest of the body.
• FluticasoneIt binds the glucocorticoid receptor most strongly of the three inhaled steroids here: nearly twice beclometasone's active form and over 3 times budesonide.

• Preventing asthma symptoms and attacks
• COPD, usually with a long-acting bronchodilator
• Allergic rhinitis (nasal sprays)

• Oral thrush (candidiasis)Known for
• Hoarse voice and sore throatKnown for
• Adrenal suppression at high dosesSerious
• Cushing-like features at high dosesSerious
• Slower growth in children
• Lower bone mineral density
• Glaucoma (raised eye pressure)Serious
• Cataracts
• Worse infections; pneumonia in COPDSerious
• Paradoxical bronchospasmSerious

What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.

• They prevent attacks but do not relieve acute bronchospasm; status asthmaticus needs other treatment.
• Rinsing the mouth with water after each dose lowers the risk of oral thrush.
• Moving from oral steroids can unmask adrenal insufficiency, so the tablets are tapered slowly.
• Strong CYP3A4 inhibitors such as ritonavir raise their levels and have caused Cushing's syndrome.

Written for biofideX in plain words, after checking these references:

• Beclomethasone dipropionate HFA inhalation aerosol: label (DailyMed)
• Fluticasone propionate inhalation powder: label (DailyMed)
• Budesonide and formoterol inhalation aerosol: label (DailyMed)
• Beclomethasone dipropionate (NCI Thesaurus)
• Beclometasone inhalers (NHS)

For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.