Update on inhaled corticosteroids: safety, compliance, and new delivery systems

Since the introduction of inhaled beclomethasone, inhaled corticosteroids have revolutionized the treatment of asthma. Inhaled corticosteroids provide the most potent and consistently effective long-term control of asthma. They have become the mainstay of therapy for chronic disease and have been recommended for asthmatics of all severities. During the past two decades, after the introduction of beclomethasone, several new inhaled corticosteroids have been introduced. With more widespread use of these agents, particularly in pediatric patients, concerns about safety have risen. These concerns emanate from the use of higher dose inhaled corticosteroids and higher potency molecules. The side effects of most concern are those that are similar to those associated with systemic corticosteroids. Recently, the U.S. Food and Drug Administration (FDA) issued a class warning of potential growth suppression in some pediatric patients using inhaled corticosteroids. Patient compliance with inhaled corticosteroid therapy is problematic. Some patients think that all inhaled corticosteroid therapy is inherently dangerous because they confuse it with systemic corticosteroid or even anabolic steroid use. Most of the products are available only as metered dose inhalers. Use of these inhalers is difficult and often poorly taught to patients. The two newest inhaled corticosteroids, budesonide and fluticasone, are available as dry powder inhalers with new delivery systems.