|
Corticosteroids |   |
While the switch to inhaled aerosol steroids has reduced the number of side effects previously seen with systemic steroid therapy, there remain some local and system side effects that need to be considered by caregivers. The following table illustrates the potential hazards and side effects associated with using inhaled aerosol corticosteroids.
| Systemic
|
Local (topical)
|
| Adrenal insufficiency1 | Oropharyngeal fungal infections |
| Extrapulmonary allergy1 | Dysphonia |
| Acute asthma1 | Cough, bronchoconstriction |
| HPA suppression (minimal, dose dependent) | Incorrect use of MDI |
| Possible growth retardation | |
| Possible osteoporosis in asthmatic patients |
1 Following transfer from systemic corticosteroid therapy.
Aerosol corticosteroid therapy is currently considered clinically indicated for:
- control of asthma
- treatment of related
steroid-responsive bronchospastic states not controlled by other therapies
- control of seasonal allergic or non-allergic rhinitis
The increased emphasis on viewing asthma as primarily a disease of inflammation leading to bronchial hyperresponsiveness has shifted the indicated use of inhaled aerosol steroids from second or third line to front line, primary therapy. The NIH's 1997 Guidelines for Diagnosis and Management of Asthma now identify aerosolized corticosteroids as long-term control therapy rather than as quick-relief for acute, severe asthmatic episodes.
The late-phase response of allergic induced bronchospasm can be mitigated or prevented by early application of inhaled steroids. In general, steroids do not replace bronchodilators, but should be used to supplement them.