Asthma Management

Introduction to Inhaled Corticosteroids

• The American Thoracic Society recommends considering the potency and equivalence of different inhaled corticosteroids when selecting a treatment, with the following equivalent daily doses:

Local Effects and Safety

• Oropharyngeal candidiasis is more common with beclomethasone dipropionate than with some other inhaled corticosteroids like triamcinolone acetonide, with a strength of evidence based on clinical studies 1
• High-dose ICS therapy may be associated with systemic effects, including potential adrenal suppression 2
• For patients with severe or refractory asthma, higher doses (>1,260 μg/day) of inhaled corticosteroids may be required, according to the American Journal of Respiratory and Critical Care Medicine 3

Dosing and Administration

• The American Academy of Allergy, Asthma, and Immunology suggests that when switching between inhaled corticosteroids, use the equivalence table to maintain appropriate anti-inflammatory effects, and consider device characteristics and patient technique when selecting an inhaled corticosteroid, with a strength of evidence based on clinical guidelines 3
• For adults with persistent asthma inadequately controlled on other therapies, 400 μg/day of QVAR provides equivalent control to 800 μg/day of budesonide DPI, as part of a strategy to optimize asthma management 4
• For non-specific cough in children with asthma risk factors, guidelines suggest a short (2-4 weeks) trial of 400 mg/day of beclomethasone equivalent, to assess the response to treatment and adjust the management plan accordingly 4
• Available ICS brand names and formulations include:

Mechanism of Action and Efficacy

• ICS reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late-phase reactions to allergens 7
• For patients with persistent asthma, ICS are the most consistently effective long-term control medication at all steps of care 7
• ICS improve asthma control more effectively than leukotriene receptor antagonists or any other single long-term control medication 7
• LABAs should never be used as monotherapy for asthma control; they must always be prescribed with an ICS 7