Asthma

● a chronic respiratory condition characterized by

airway inflammation, bronchoconstriction, and
increased mucus production.
● Corticosteroids, also known as steroids, have
revolutionized the treatment of asthma and are
considered a cornerstone of asthma pharmacology.
 Corticosteroid
Pharmacology of corticosteroids in asthma, their mechanisms of action,
types, administration, and their role in asthma management.
Corticosteroid drugs
● also known as steroids or corticosteroids, are
commonly used in the treatment of asthma to
reduce airway inflammation and control
symptoms
● They are considered one of the most effective
long-term treatments for asthma.
Mechanisms of Action
● Corticosteroids exert their beneficial effects in
asthma by primarily targeting airway
inflammation.
Key mechanisms of action of Corticosteroid
❖ Suppression of Inflammation: Corticosteroids reduce
inflammation by inhibiting the production of pro-inflammatory
molecules such as cytokines and leukotrienes.
❖ Immune Suppression: They suppress the immune response,
decreasing the infiltration of inflammatory cells into the airways.
❖ Bronchodilation: Corticosteroids can indirectly enhance
bronchodilation by reducing inflammation and airway
hyperresponsiveness.
❖ Reduced Mucus Production: They decrease mucus production
by inhibiting mucus-producing cells.
Two main types of corticosteroids used in asthma
management:
1. Inhaled Corticosteroids (ICS): Delivered via inhalers or
nebulizers, ICS are the primary choice for long-term
asthma control.
2. Oral Corticosteroids (Systemic): Reserved for severe
exacerbations or when ICS are insufficient. Choice for
short-term asthma control.
1. Inhaled corticosteroids are the most commonly
prescribed type of corticosteroids for asthma.
● They are administered via inhalers or nebulizers,
allowing the medication to be delivered directly to
the lungs.
● Inhaled corticosteroids work by reducing
inflammation in the airways and suppressing the
immune response that leads to asthma symptoms.
● Examples of inhaled corticosteroids include:
● Fluticasone (e.g., Flovent)
● Budesonide (e.g., Pulmicort)
● Beclomethasone (e.g., QVAR)
● Mometasone (e.g., Asmanex)
● Ciclesonide (e.g., Alvesco)
Corticosteroid drugs used in asthma, including
Fluticasone, Budesonide, Beclomethasone,
Mometasone, and Ciclesonide, work through a similar
mechanism of action. They reduce airway
inflammation, which is a key factor in the development
of asthma symptoms.
1. Fluticasone (e.g., Flovent):

● Mechanism of Action: Fluticasone is an inhaled corticosteroid

(ICS) that works by suppressing the inflammatory response in
the airways. It inhibits the production of inflammatory cytokines,
reducing airway inflammation and mucus production.
● Typical Dosage: Dosages may vary based on the specific
product and the severity of asthma. Common dosages range
from 100 mcg to 500 mcg inhaled twice daily for adults.
● Common Side Effects: Common side effects of Fluticasone may
include throat irritation, cough, and hoarseness. These side
effects are often minimized by using a spacer device and rinsing
the mouth after inhalation.
2. Budesonide (e.g., Pulmicort):

● Mechanism of Action: Budesonide, like other ICS, reduces

airway inflammation by inhibiting the production of
inflammatory mediators.
● Typical Dosage: Budesonide is available in various forms,
including inhalers and nebulizer solutions. Dosages range
from 200 mcg to 800 mcg inhaled twice daily for adults.
● Common Side Effects: Side effects are generally similar to
Fluticasone and may include throat irritation, cough, and
hoarseness. Using a spacer and mouth rinsing can help
minimize these effects.
3. Beclomethasone (e.g., QVAR):

● Mechanism of Action: Beclomethasone reduces

airway inflammation and suppresses the immune
response in the lungs.
● Typical Dosage: Dosages for Beclomethasone range
from 40 mcg to 320 mcg inhaled twice daily for adults.
● Common Side Effects: Similar to other ICS, common
side effects include throat irritation, cough, and
hoarseness.
4. Mometasone (e.g., Asmanex):

● Mechanism of Action: Mometasone acts as an

anti-inflammatory agent in the airways, reducing
inflammation and symptoms.
● Typical Dosage: Dosages for Mometasone range from
100 mcg to 400 mcg inhaled once daily for adults.
● Common Side Effects: Side effects are generally mild
and may include throat irritation, cough, and
hoarseness.
5. Ciclesonide (e.g., Alvesco):

● Mechanism of Action: Ciclesonide is an ICS that acts

locally in the airways, reducing inflammation and
mucus production.
● Typical Dosage: Dosages typically range from 80 mcg
to 320 mcg inhaled once daily for adults.
● Common Side Effects: Common side effects are
similar to other ICS and include throat irritation,
cough, and hoarseness.
Oral Corticosteroids (Systemic Corticosteroids):
● Oral corticosteroids are reserved for severe
asthma exacerbations or when other treatments
are not effective in controlling symptoms.
● They are taken in tablet or liquid form and have a
systemic effect throughout the body.
● Oral corticosteroids help reduce inflammation and
provide quick relief during asthma attacks.
● Examples of oral corticosteroids include:
● Prednisone
● Prednisolone
● Methylprednisolone
● Dexamethasone
Corticosteroid drugs used in asthma, including
Prednisone, Prednisolone, Methylprednisolone, and
Dexamethasone, have anti-inflammatory and
immunosuppressive properties.
 1. Prednisone:

● Mechanism of Action: Prednisone is a synthetic corticosteroid that works

by suppressing the immune response and reducing inflammation in the
airways. It inhibits the production of inflammatory cytokines and immune
cells.
● Typical Dosage: The dosage of Prednisone varies based on the severity of
asthma exacerbation but commonly ranges from 40 mg to 60 mg daily for
a few days.
● Common Side Effects: Common side effects may include increased
appetite, weight gain, mood changes, increased risk of infections, and
temporary increases in blood sugar levels. Prolonged use can lead to more
significant side effects, such as osteoporosis and adrenal suppression.
2. Prednisolone:
● Mechanism of Action: Prednisolone, a precursor of
Prednisone, has similar anti-inflammatory and
immunosuppressive effects.
● Typical Dosage: Dosages for Prednisolone in asthma
exacerbations are typically similar to those of Prednisone,
ranging from 40 mg to 60 mg daily for a few days.
● Common Side Effects: Side effects are similar to
Prednisone and include increased appetite, weight gain,
mood changes, and increased risk of infections. Adverse
effects on bone health and adrenal function can occur with
prolonged use.
3. Methylprednisolone:
● Mechanism of Action: Methylprednisolone is another synthetic
corticosteroid that exerts anti-inflammatory and
immunosuppressive effects.
● Typical Dosage: Dosages for Methylprednisolone during
asthma exacerbations are often similar to Prednisone and
Prednisolone, ranging from 40 mg to 60 mg daily for a few
days.
● Common Side Effects: Side effects include those commonly
associated with corticosteroids, such as mood changes,
increased appetite, weight gain, and an increased susceptibility
to infections. Prolonged use may lead to bone loss and adrenal
suppression.
4. Dexamethasone:

● Mechanism of Action: Dexamethasone, a potent synthetic

corticosteroid, has anti-inflammatory and immunosuppressive
properties similar to other corticosteroids.
● Typical Dosage: The dosage of Dexamethasone used in asthma
exacerbations is typically lower than that of Prednisone or
Prednisolone, often starting with 4 mg or 6 mg daily for a few
days.
● Common Side Effects: Side effects are similar to other
corticosteroids and may include mood changes, increased
appetite, weight gain, and susceptibility to infections. Long-term
use can lead to bone thinning and adrenal suppression.
Role in Asthma Management:
➢ Long-Term Control: ICS are fundamental for maintaining asthma control
by reducing airway inflammation and preventing exacerbations.
➢ Quick Relief: Oral corticosteroids provide rapid symptom relief during
severe asthma attacks.
➢ Stepwise Approach: Corticosteroids are often used in conjunction with
other asthma medications, forming the basis of the stepwise approach to
asthma treatment recommended by guidelines.
➢ Reducing Airway Remodeling: Long-term ICS use may help prevent
airway remodeling, a process associated with worsening asthma over
time.
Common side effects
● weight gain
● mood changes
● increased risk of infections
● osteoporosis