Written by Ujwal Aluru
Corticosteroids are medications that are often used to treat and combat the symptoms caused by respiratory diseases. The most common response to asthma patients when they consult a doctor for discomfort with respiratory problems is to increase the dose of ICS (inhaled corticosteroids). In retrospect, this has not always proven effective.
Considering the fact that corticosteroids are the standard prescription for asthma, one would expect them to act as a generic medicine to control patients’ symptoms. However, a controlled study involving escalating ICS treatment of asthma patients shows that this method was ineffective in treating exacerbations. About 41% of people with escalated treatment had uncontrolled asthma after one year of treatment [1]. Furthermore, the use of corticosteroids along with LABA agonists (an inhaled medication that is used to treat asthma and chronic obstructive pulmonary disease [COPD] reduced the risk of exacerbations in COPD. In this scenario, the increase in corticosteroid therapy was useful in dealing with the symptoms of COPD, but there was a risk of increased pneumonia by 43%-78% and there were more immunosuppressive effects present in the local airways [2]. The main problem with increased corticosteroid treatment and its correlation to pneumonia is that the fluticasone propionate molecules (steroid molecules that prevent inflammation) are metabolized at a slower rate in the lungs and often linger within the epithelial lining of the airways. This can lead to more severe respiratory problems in the future and may expose the body to different pathogens that it would normally be protected against.
Corticosteroids are available in three types: topical, systemic, and inhaled. Inhaled corticosteroids are the most prescribed steroids for respiratory problems. Topical corticosteroids are not utilized as a treatment for respiratory problems since they are a cream used for skin. Systemic corticosteroids, usually administered orally, are used for severe respiratory problems such as asthma attacks. Systemic corticosteroids pose a greater risk than inhaled corticosteroids, as they can leave the body vulnerable to other diseases while failing to reduce the symptoms of the initial problem. When faced with severe respiratory problems, an increase in corticosteroid administration does not cater to all the population. Therefore, it is important to be cognizant of risks of following generalized treatment escalation.
References:
1. Bengtson, Lindsay GS, et al. “Inhaled Corticosteroid-Containing Treatment Escalation and Outcomes for Patients with Asthma in a US Health Care Organization.” Journal of Managed Care & Specialty Pharmacy 23.11 (2017): 1149-1159.
2. Janson, Christer, et al. “Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD.” International Journal of Chronic Obstructive Pulmonary Disease 12 (2017): 3055.
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