Treatment of asthma with glucocorticosteroids

Glucocorticosteroids (GCS) are used to treat asthma that does not respond to accepted first-line therapy. Because they have potent anti-inflammatory properties, facilitate beta-adrenergic responsiveness, suppress the late-phase reaction and reduce secretion of mucus, GCS are indicated in the treatment of severe acute asthma and chronic asthma not responsive to beta-agonists and methylxanthines. They are also useful as a diagnostic tool to determine reversibility of airway obstruction in some patients with chronic obstructive pulmonary disease. Maximal antiasthmatic effect is achieved by prescribing daily divided doses of intermediate-acting systemic GCS and reducing the dosage to alternate days after the asthma has been controlled. Inhaled GCS have minimal systemic effects when used properly, and in selected cases may be as effective as the oral preparations. Improper use of these drugs may provoke side effects which are undesirable and dangerous. Proper patient education in the use of these drugs is necessary to avoid such severe adverse effects.