Inhaled Steroids for Asthma Management in Patients with Chronic MAC Infection

Rationale for Using Inhaled Steroids in Asthma

Inhaled corticosteroids are the cornerstone of asthma management, effectively suppressing airway inflammation which is central to asthma pathophysiology, as recommended by the American Thoracic Society 1, 2

Start with standard antiasthmatic regimen of inhaled bronchodilators and inhaled corticosteroids, as suggested by the American College of Chest Physicians 1
Partial improvement often occurs after 1 week of inhaled bronchodilator therapy, but complete resolution of cough may require up to 8 weeks of treatment with inhaled corticosteroids, according to the British Medical Journal 1
Consider using spacer devices with inhaled steroids to increase effectiveness and potentially reduce the dose needed, as recommended by the British Medical Journal 2, 3
Ensure proper inhaler technique to maximize benefit while minimizing dose requirements, as suggested by the British Medical Journal 4

Some inhaled steroid formulations may induce or exacerbate cough due to components in the aerosol, such as beclomethasone dipropionate, which more commonly causes cough than triamcinolone acetonide, as reported by the American College of Chest Physicians 1
If cough worsens after starting inhaled steroids, consider the possibility of inhaled steroid-induced cough, improper use of the inhaler device, or presence of another etiology making asthma difficult to control, as recommended by the American College of Chest Physicians 1

For severe or partially responsive cough, oral corticosteroid therapy, such as prednisone 40 mg daily for 1 week, may be necessary, alone or followed by inhaled therapy, as suggested by the American College of Chest Physicians 1
In patients whose cough remains refractory to inhaled corticosteroids, assessment of airway inflammation can identify those who may benefit from more aggressive anti-inflammatory therapy, according to the American College of Chest Physicians 1

Regular follow-up to assess asthma control and potential impact on MAC infection is necessary, as recommended by the British Thoracic Society 5, 6
Monitor for any signs of worsening respiratory status that could indicate progression of MAC infection, as suggested by the American College of Chest Physicians 1
Consider step-down of inhaled steroid dose once asthma is well-controlled for a period of 1-3 months, as recommended by the British Medical Journal 4, 7