Oral Corticosteroids

  1. Five oral corticosteroids approved in the US are Beclomethasone dipropionate (QVAR), flunisolide (Aerobid), flunisolide hemihydrate HFA (AeroSpan), fluticasone propionate (Flovent) and budesonide (Pulmicort).
  2. The major therapeutic effect of corticosteroids is their anti inflammatory action such as bone loss (osteoporosis), significant weight gain, acne, cataracts, increased susceptibility to infection due to suppressed immune system, psychosis, bruising, thinning of the skin, hair growth, anxiety, insomnia, headaches, mood swings and stunted growth in children .
  3. Both COPD and Asthma can be treated for inflammation using corticosteroids.
  4. The assumption is that inhaled corticosteroids would have a local effect and not any systemic effects like oral drugs have, thus not interfering with the body’s endogenous (the body’s own) corticosteroid regulation.
  5. Beta agonists relieve the early phase of bronchoconstriction in asthma, while the corticosteroids are effective in both early and late stage relief of asthmatic bronchoconstriction.
  6. Oral corticosteroids generally depress the endogenous regulatory activity (HPA) resulting in a variety of related imbalances; growth in children is blocked, bone density is decreased, adrenal steroid secretion compromised, etc.
  7. Since oral steroid use suppresses the patient’s indigenous corticosteroid secretion, care should be taken to taper off the oral therapy while administering aerosolized therapy. This would allow the endogenous secretions to resume gradually.
  8. Oral thrush is a common side effect of inhaled steroids.
  9. The way to reduce thrush is to direct the steroid to the lung bronchi away from the oropharynx. This can be done with a reservoir device on the MDI. Also rinsing the mouth will prevent corticosteroid buildup in the oropharynx.
  10. Inhaled corticosteroids do not act fast enough to be an effective therapy against acute onset asthma. They are a good compliment to fast acting beta adrenergics for longer term management of asthma.

Things discussed in class:

As we previously discussed, respiratory therapists are responsible for ensuring that a patient has airways that are unobstructed and are able to move air into and out of the lungs. Common respiratory conditions that impair a person’s ability to breathe can be classified as either restrictive or obstructive. Obstructive lung disorders can be remembered by using the acronym CBABE. Cystic fibrosis, Bronchitis (chronic), Asthma, Bronchiectasis, and Emphysema. Patients affected by obstructive conditions suffer from decreased airflow due to partial or full blockage of the airways. There are three factors that are primarily responsible for causing obstruction of the bronchioles and include: bronchoconstriction, inflammation of the airway mucosa, and overproduction of thick, sticky mucus. Bronchodilators are used to treat bronchoconstriction and mucolytic or mucoactive agents are used to help mobilize thick, sticky retained secretions. Corticosteroids are used to reduce inflammation.

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Corticosteroids are medications that decrease inflammation (swelling) and reduce the activity of the immune system. They prevent and are used to treat a variety of conditions such as a skin rash, arthritis, allergies, and breathing conditions such as asthma and COPD. Corticosteroids mimic the effects of cortisol, a hormone that the adrenal glands naturally produce in the body. When corticosteroids are prescribed in quantities that exceed levels naturally found in the body, they suppress inflammation. Common types of steroids include:
Prednisone
Cortisone (Hydrocortisone)
Methylprednisolone (Solu-Medrol)

These types of steroids are available in oral form, intravenously (IV) and intramuscularly (into muscle). Some common side effects of using these routes includes immunosuppression, increased susceptibility to infections, hypertension, insomnia, and thin skin. Steroids can be given to the exact place where the problem exists (locally) or can be given systemically which means throughout the body. Systemic steroids are those medications that are given orally or intravenously.

Corticosteroids are valuable in the treatment of airway inflammation, which results in reduction of the airway diameter making it difficult for air to move into and out of the lungs. Treatment of airway inflammation includes administering steroids through inhalation, oral and parenteral routes. Common inhaled steroids include:
Beclomethasone diproprionate (QVAR)
Budesonide (Pulmicort)
Flunisolide (Aerobid)
Flunisolide hemihydrate HFA (AeroSpan)
Fluticasone propionate (Flovent)

Inhaled corticosteroids have less systemic side effects than oral or parenteral routes because they are distributed locally to the site of the inflammation. Inhaled corticosteroids are the most effective anti-inflammatory agents for the long-term control of persistent asthma including allergic asthma. Corticosteroids can be given in combination with long-acting bronchodilators for the treatment of asthma such as Advair. Advair contains the corticosteroid fluticasone (Flovent) and the long-acting beta-adrenergic bronchodilator salmeterol (Serevent) and is an inhaled medication delivered through a device called a dry powder inhaler (DPI). DPI’s deliver medication to the lungs in the form of a dry powder from a capsule placed in a small, hand-held device. Typical side effects from aerosol administration include oropharyngeal fungal infections, with the most common being thrush (Candida yeast infection). Encouraging patients to rinse their mouth out after each use can prevent this infection. Other possible side effects include changes in voice and/or hoarseness.

Treatment with corticosteroids is recommended for short term use only and should only be used long term when necessary. Typical side effects from long term use of systemic administration include bone loss (osteoporosis), significant weight gain, acne, cataracts, increased susceptibility to infection due to suppressed immune system, psychosis, bruising, thinning of the skin, hair growth, anxiety, insomnia, headaches, mood swings and stunted growth in children. Steroid use should never be abruptly discontinued because it can have a negative affect on the adrenal glands. When discontinuing the use of steroids, a person should slowly taper off to allow the adrenal glands time to return to their normal patterns of hormone secretion.

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