Clinical considerations in the use of inhaled corticosteroids for asthma

Inhaled corticosteroids are the most potent and effective therapy for treating asthma. They exert their pharmacologic action through activation of the glucocorticoid receptor, which helps regulate gene transcription. Corticosteroids also directly inhibit several inflammatory mediators involved in the pathophysiology of asthma. In randomized, controlled clinical trials, inhaled corticosteroids, as monotherapy, are superior to other therapies in improving lung function and clinical outcomes in patients with asthma. However, the use of inhaled corticosteroids is limited by concerns of dose-related adverse effects, including growth suppression and decreased bone density. Combination regimens with these agents and other long-term therapies are beneficial in maintaining asthma control while minimizing dose-related toxicities. Several inhaled corticosteroid products are available in the United States. They differ in potency; however, clinical efficacy is similar when equipotent doses are administered. A variety of factors influence product selection and patient response, including the therapeutic ratio, pharmacokinetic properties, and the inhalation delivery device. In addition, adherence to therapy and the patient's skill in administering the inhaled drug contribute to the therapeutic outcome.