In the United States, inhaled corticosteroids are approved for chronic control of asthma symptoms. They are not rescue drugs?those intended to treat an exacerbation (acute attack) of asthma symptoms?because their effects must develop over time. Instead, they are considered to be controllers or medications that are used to prevent the occurrence of asthma attacks. Exactly how inhaled corticosteroids work to prevent asthma attacks is still not fully understood; but they are known to reduce inflammation in the airways; possibly by suppressing the body's production of substances that trigger and maintain inflammation. Typically, inhaled corticosteroids are used for patients whose asthma requires frequent use of a rescue medication (usually a short-acting inhaled beta-2 agonist).

Drugs in this Class
Fluticasone Inhaler (Flovent HFA Inhalation Aerosol, Fluticasone Propionate Inhaler)
Beclomethasone Oral Solution Inhalation (QVAR)
Fluticasone Powder for Inhalation  (Flovent Diskus Powder for Inhalation, Fluticasone Propionate Powder for Inhalation )
Flunisolide Pressurized Inhalation (Aerobid Inhalation Aerosol, Aerobid M Inhalation Aerosol, Flunisolide Aerosol, Flunisolide Inhalation Aerosol, Flunisolide Inhaler)
Mometasone Powder for Inhalation  (Asmanex Twisthaler, Mometasone Furoate Powder for Inhalation )
Budesonide Inhalation Powder (Pulmicort Flexhaler )

Summarizing the Evidence

• When used in recommended doses, all inhaled corticosteroid have about the same effectiveness. In numerous studies, inhaled corticosteroids have shown superior effectiveness to placebo (inactive inhaler), but no clinical studies have compared all inhaled corticosteroids directly.
• Generally, the selection of inhaled corticosteroid is based on specific symptoms or asthma severity, the patient?s experience with previous treatment, other diseases or conditions the patient may have, the doctor's preference, and other medications the patient is taking (to avoid potential drug interactions).
• Inhaled corticosteroids have different potencies (the relative amount needed to produce the desired effect). Even though higher potency does not always mean greater effectiveness, inhaled corticosteroids with higher potencies may require fewer inhalations to control asthma. A 2002 update of the National Asthma Education and Prevention Program?s Expert Panel Report ?Guidelines for the Diagnosis and Management of Asthma?, ranks the relative potencies of inhaled corticosteroids as fluticasone being most potent, then beclomethasone and budesonide, followed by triamcinolone and flunisolide. Mometasone is a high-potency corticosteroid that was approved in 2005.

Dosing and Administration

• For the prevention and/or treatment of asthma attacks, typical dosage is one inhalation or two inhalations twice daily for beclomethasone, budesonide, flunisolide, and fluticasone. However, mometasone is recommended for once-daily use and triamcinolone can be inhaled up to four times daily. The number of daily inhalations can be increased according to severity of asthma symptoms, but each corticosteroid has a maximum recommended dose that should not be exceeded per day. Higher doses may also increase the risk of adverse effects.
• Currently, budesonide and fluticasone are the only inhaled corticosteroids available in dry-powder forms.
• With the exception of fluticasone and mometasone, all inhaled corticosteroids can be used in children who are 6 years old or older. Fluticasone inhalers can be used for patients 12 years of age and older, and the dry powder forms of fluticasone can be used for patients who are at least 4 years of age. Mometasone is meant for patients who are 12 or older.
• Devices known as spacers can improve the effectiveness of inhaled corticosteroids. A spacer is a tube that attaches to the inhaler at one end. The corticosteroid is sprayed into the spacer and then the patient breathes in and out slowly several times from the other end of the spacer. As a result, less medication is wasted and more gets into the lungs where it is needed. Because they reduce the amount of medication that remains in the mouth, spacers can also reduce the chance of getting a candida (yeast) infection in the mouth. Currently, only the triamcinolone inhaler comes with a spacer attached. However, spacers can be purchased separately for use with the other inhaled corticosteroids. Spacers cannot be used with dry-powder inhalers.

Generic Availability

• None of the inhaled corticosteroids is available generically.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

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Last Updated: May 2007

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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