Inhaled Corticosteroid Therapies in Asthma Management
Summary
Inhaled corticosteroids (ICS) constitute the cornerstone of long-term asthma control by directly suppressing airway inflammation, reducing airway hyperresponsiveness and preventing exacerbations. Delivered via metered-dose inhalers, dry-powder inhalers or nebulisers, ICS achieve high local efficacy with minimal systemic exposure. Key agents include fluticasone propionate, budesonide, ciclesonide and beclomethasone, often formulated alone or in fixed combinations with long-acting β₂-agonists (LABA) such as formoterol or vilanterol. Contemporary guidelines recommend tailored dosing based on disease severity, with as-needed ICS–LABA regimens gaining traction to optimise adherence and limit cumulative steroid burden. While ICS dramatically improve symptoms and lung function, dose-related risks—adrenal suppression, slight impact on paediatric growth and rare infective complications—require vigilant monitoring, device education and regular review to balance efficacy and safety in diverse populations worldwide.
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Inhaled Corticosteroid Therapies in Asthma Management publication trend
The graph below shows the total number of articles in inhaled corticosteroid therapies in asthma management across all publications each year (not limited to Nature Index journals).
Technical terms
Inhaled corticosteroid (ICS): A topical anti-inflammatory medication administered by inhalation to treat and prevent airway inflammation in asthma.
Glucocorticoid receptor: An intracellular protein that binds corticosteroids to regulate genes involved in inflammation control.
Airway hyperresponsiveness: An exaggerated narrowing of the airways in response to stimuli, characteristic of asthma.
Fractional exhaled nitric oxide (FeNO): A non-invasive biomarker measured in breath that reflects airway eosinophilic inflammation.
Bronchodilator: A drug that relaxes bronchial smooth muscle to widen airways and improve airflow.
Adrenal suppression: A reduction in endogenous cortisol production due to prolonged exposure to exogenous corticosteroids.
References
- Inhaled Corticosteroids. Pharmaceuticals (2010).
- Systemic Effects of Inhaled Corticosteroids: An Overview. The Open Respiratory Medicine Journal (2014).
- Human receptor kinetics and lung tissue retention of the enhanced-affinity glucocorticoid fluticasone furoate. Respiratory Research (2007).
- Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomised controlled trial. Respiratory Research (2018).
- Asthma and treatment with inhaled corticosteroids: associations with hospitalisations with pneumonia. BMC Pulmonary Medicine (2019).
- Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma. BMC Pediatrics (2019).
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