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Inhaled corticosteroids for asthma: are they all the same?
1Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
Journal of Clinical Pharmacy and Therapeutics
|January 8, 2009
Summary
This study compares inhaled corticosteroids (ICS) for asthma, highlighting differences in formulations and delivery systems. These variations impact therapeutic efficacy and safety profiles for patients.
Area of Science:
- Pharmacology
- Respiratory Medicine
Background:
- Inhaled corticosteroids (ICS) are a cornerstone therapy for asthma management.
- Variations exist among currently available ICS in terms of formulation and delivery systems.
Purpose of the Study:
- To evaluate similarities and differences among available ICS for asthma treatment.
- To emphasize factors influencing the relative safety of these medications.
Main Methods:
- A comprehensive literature search of PubMed was conducted for relevant reviews and original articles.
- Information from retrieved studies was synthesized and critically evaluated.
Main Results:
- Differences in ICS formulations and delivery systems influence therapeutic efficacy and safety.
- Prodrug formulations (ciclesonide, beclomethasone dipropionate) minimize oropharyngeal side effects.
- Systemic absorption and metabolism vary, with rapid hepatic metabolism for most ICS and additional extrahepatic metabolism for ciclesonide.
- High serum protein binding of ciclesonide and mometasone reduces extra-pulmonary glucocorticoid receptor stimulation.
Conclusions:
- Despite similar mechanisms of action, ICS and their delivery systems exhibit distinct characteristics.
- These differences can impact individual patient safety and therapeutic effectiveness.
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