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Updates on the use of inhaled corticosteroids in asthma

Stoloff, Stuart W.; Kelly, H.W.

Current Opinion in Allergy and Clinical Immunology: August 2011 - Volume 11 - Issue 4 - p 337–344
doi: 10.1097/ACI.0b013e328348a813
Pharmacotherapy and evidence based medicine: Edited by David A. Khan and Enrico Compalati

Purpose of review The purpose of this review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs in terms of pharmacodynamic and pharmacokinetic properties and how these affect comparative efficacy. In addition, clinical dosing strategies for ICSs including as-needed use will be explored.

Recent findings Ciclesonide has demonstrated similar efficacy to that of fluticasone propionate and mometasone furoate in equipotent doses with a potentially improved therapeutic index. Once-daily administration of ICSs is generally not as effective as twice-daily. Continuous administration of ICSs does not change the natural history of asthma in either children or adults. Long-term administration of medium dose ICSs does not increase the risk of cataracts or osteopenia in children and young adults. Studies of as-needed ICSs in mild persistent asthma in adults and children have demonstrated mixed results, with some showing equal efficacy to continuous therapy and others showing superiority of continuous therapy.

Summary Ciclesonide provides a newer ICS with favorable pharmacokinetics that may improve the therapeutic index, but assessment of its systemic effects such as growth await further studies. Continuous administration of ICSs in low to medium dose over many years is well tolerated. The use of as-needed ICSs in patients with mild persistent asthma is promising as a potential step-down therapy but awaits further studies.

aDepartment of Family and Community Medicine, University of Nevada School of Medicine, Reno, Nevada

bDepartment of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

Correspondence to Stuart W. Stoloff, MD, FAAAAI, FAAFP, 1200 Mountain Street, Suite 220, Carson City, NV 89703, USA Tel: +1 775 883 6888; fax: +1 775 883 6524; e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.