Table of ContentsView AllTable of ContentsTypesHow They WorkHow They’re UsedDosages and UseSide EffectsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types
How They Work
How They’re Used
Dosages and Use
Side Effects
Frequently Asked Questions
Inhaled corticosteroids, also called inhaled steroids, are medications used for long-term management ofasthma. They typically are the preferred treatment for people with asthma who need more than a rescue inhaler can offer.
Inhaled steroids help preventsymptoms of asthma, including wheezing, shortness of breath, coughing, and tightness in the chest. These inhalers are not effective for treating an acute asthma attack. Instead, they are to be used daily—symptoms or not—to control asthma over time.
When used as prescribed, inhaled steroids can:
Your healthcare provider may recommend an inhaled steroid for your asthma if any of these factors apply:
Types of Inhaled Steroids
Laura Porter / Verywell
Healthcare providers prescribe steroids for individual patients based on factors such as the severity of their asthma and their overall health:
Some steroid inhalers contain only a corticosteroid, such as:
Others contain a steroid plus along-term beta-agonist (LABA), a type of bronchodilator that is effective for up to 12 hours. Known ascombination therapies, these inhalers typically are prescribed for people with poorly controlled asthma symptoms.
Common Misunderstanding
How Inhaled Steroids Work
Asthma is essentially an overactive response of the immune system to something in the environment.
When you come in contact with an asthma trigger (an allergen such as pet dander, smoke, etc.), your immune system releases cells that causeinflammationin your bronchial tubes (airways). This narrows them and makes it hard to breathe.
Inhaled corticosteroids reduce this inflammation. They also reduce the amount of mucus in your bronchial tubes. The result is clear and open airways that allow you to breathe normally.
Raising Hormone Levels
In asthma, inflammation of the airways can become chronic.Everyday levels are lower than those during anasthma attack, but that constant state of inflammation means it doesn’t take much of a response to challenge your breathing.
Your body produces hormones that regulate the immune response and inflammation, and steroids are synthetic versions of those hormones. When you take a corticosteroid, your body detects high levels of the hormone and stops producing it, effectively “taking its foot off the accelerator.”
Blocking Allergy Response
Steroids block the late-phase immune reaction to allergens, which lowers inflammation, decreases over-responsiveness of the bronchial tubes, and blocks the immune system’s inflammatory cells.
The excess mucus associated with asthma comes directly from the bronchial tubes as part of the inflammatory response, so lowering inflammation can help lessen mucus as well.
This anti-inflammatory response is central to achieving long-term control of your asthma.
Asthma and Your Immune System
Effects of Combination Ingredients
Choosing an Corticosteroid Inhaler
Inhaled steroids come in three different types of devices:
When choosing an inhaler, one of the main considerations is how much of the drug exiting the inhaler is actually deposited in the air passages of the lungs. By and large, DPIs tend to deliver more active drug than MDIs.This doesn’t necessarily mean the therapeutic effects of MDIs are any less than that of the DPIs; they generally aren’t. It may only pose a problem if a spacer is used.
Dosages of inhaled corticosteroids varies widely depending on the specific drug, age, and the severity of asthma symptoms.
People with asthma who use an inhaled steroid to control symptoms routinely have been instructed to take one to two puffs once or twice a day—sometimes more.
However, in updated recommendations for asthma management issued in December 2020, the National Institutes of Health advised that for some people with mild to moderate persistent asthma, daily inhaler use may not be necessary.If you use an inhaler daily to manage asthma, talk to your healthcare provider about how the new guidelines might affect your treatment.
It’s important to follow the instructions provided to you precisely, as thedoses need to be spacedjust right for the medication to be effective. Also, taking more medication than directed can cause you to have unpleasant side effects.
How Do Inhalers Work?
Duration
It’s worth repeating: These are long-term medications for daily use, not rescue inhalers that you used to end an asthma attack. Inhaled corticosteroids are intended to be used regularly, likely over the course of many years.
Talk to your healthcare provider before stopping your medication for any reason.
Generally speaking, inhaled corticosteroids have a relatively low risk of side effects, particularly when compared tooral corticosteroids. The most common ones affect fewer than 5% of people who use them.
Some side effects result when the medication and/or propellant comes in contact with tissues in the mouth and throat. Others are systemic, meaning they stem from the medication circulating through your body.
Mouth and Throat
These common side effects of oral corticosteroids often are easy to manage or even eliminate altogether.
Systemic
Systemic side effects are possible but uncommon with inhaled steroids. The risk generally is higher with a higher dose.
Talk to your pediatrician if you have concerns about your child’s growth. It’s also important to consider, though, that poorly controlled asthma can also impair growth.
Other systemic side effects can include:
Again, these are less common at typical dosages. If you already have a high risk of any of these things, are concerned about them, or suspect you’re experiencing one, talk to your healthcare provider.
Serious systemic symptoms may arise when the daily dosage is high—1,000 to 1,500 micrograms (mcg) per day—increasing the risk of the above side effects, plus:
Most inhaled corticosteroids fall beneath this threshold. Comparatively speaking, a high corticosteroid dose without a spacer is defined as:
Pregnancy and Breastfeeding
Research suggests inhaled corticosteroids do not increase the risk of birth defects and that they’re safe to use in low doses throughout pregnancy.
Your practitioner may recommend one drug over another based on absorption levels.
A Word From Verywell
You have a lot of factors to weigh when selecting the right inhaled corticosteroid for your asthma. Some may be based on the known differences between the drugs; others may be based on personal preference or other considerations (such ashealth coverageand availablepatient assistance programs).
The right inhaler is the one that works for you. It’s often necessary to try several to see how they work or if you experience any side effects.
While your first instinct may be to choose the latest drug, remember new doesn’t always mean best. Opt for the drug that controls your symptoms with the lowest dose and fewest side effects.
Frequently Asked QuestionsFlonase and Flovent contain the same active ingredient, fluticasone. However, Flonase is delivered as a nasal spray used to treat sinus allergies and Flovent is used as an inhaler to treat asthma. The brand name Flovent is no longer available, but authorized generics identical to Flovent are available.Pulmicort and Symbicort are two inhaled medications used to treat asthma. Pulmicort contains budesonide, a corticosteroid. Symbicort combines budesonide with formoterol, a long-term beta-agonist (LABA).Pulmicort (budesonide) comes in both an inhaler and a nebulizer solution. Pulmicort Flexhaler is a portable inhaler. Pulmicort Respules is the nebulizer solution.
Flonase and Flovent contain the same active ingredient, fluticasone. However, Flonase is delivered as a nasal spray used to treat sinus allergies and Flovent is used as an inhaler to treat asthma. The brand name Flovent is no longer available, but authorized generics identical to Flovent are available.
Pulmicort and Symbicort are two inhaled medications used to treat asthma. Pulmicort contains budesonide, a corticosteroid. Symbicort combines budesonide with formoterol, a long-term beta-agonist (LABA).
Pulmicort (budesonide) comes in both an inhaler and a nebulizer solution. Pulmicort Flexhaler is a portable inhaler. Pulmicort Respules is the nebulizer solution.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The American Academy of Allergy, Asthma & Immunology.Corticosteroids definition.Liang TZ, Chao JH.Inhaled Corticosteroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470556/American Academy of Allergy Asthma & Immunology.AAAAI Allergy & asthma medication guide.Ishmael FT.The inflammatory response in the pathogenesis of asthma.J Am Osteopath Assoc. 2011;111(11 Suppl 7):S11-S17.Cazzola M, Page CP, Rogliani P, Matera MG.β2-agonist therapy in lung disease.Am J Respir Crit Care Med. 2013;187(7):690-696. doi:10.1164/rccm.201209-1739PPGosens R, Gross N.The mode of action of anticholinergics in asthma.Eur Respir J.2018;52(4) doi:10.1183/13993003.01247-2017Ye Q, He XO, D’Urzo A.A review on the safety and efficacy of inhaled corticosteroids in the management of asthma.Pulm Ther(2017) 3:1. doi:10.1007/s41030-017-0043-5Cloutier MM, Baptist AP, Blake KV, et al.2020 focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group.Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003Smy L, Chan AC, Bozzo P, Koren G.Is it safe to use inhaled corticosteroids in pregnancy?.Can Fam Physician. 2014;60(9):809-12, e433-5.National Center for Biotechnology Information, U.S. National Library of Medicine: Drugs and Lactation Database (LactMed).Fluticasone, inhaled.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The American Academy of Allergy, Asthma & Immunology.Corticosteroids definition.Liang TZ, Chao JH.Inhaled Corticosteroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470556/American Academy of Allergy Asthma & Immunology.AAAAI Allergy & asthma medication guide.Ishmael FT.The inflammatory response in the pathogenesis of asthma.J Am Osteopath Assoc. 2011;111(11 Suppl 7):S11-S17.Cazzola M, Page CP, Rogliani P, Matera MG.β2-agonist therapy in lung disease.Am J Respir Crit Care Med. 2013;187(7):690-696. doi:10.1164/rccm.201209-1739PPGosens R, Gross N.The mode of action of anticholinergics in asthma.Eur Respir J.2018;52(4) doi:10.1183/13993003.01247-2017Ye Q, He XO, D’Urzo A.A review on the safety and efficacy of inhaled corticosteroids in the management of asthma.Pulm Ther(2017) 3:1. doi:10.1007/s41030-017-0043-5Cloutier MM, Baptist AP, Blake KV, et al.2020 focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group.Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003Smy L, Chan AC, Bozzo P, Koren G.Is it safe to use inhaled corticosteroids in pregnancy?.Can Fam Physician. 2014;60(9):809-12, e433-5.National Center for Biotechnology Information, U.S. National Library of Medicine: Drugs and Lactation Database (LactMed).Fluticasone, inhaled.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The American Academy of Allergy, Asthma & Immunology.Corticosteroids definition.Liang TZ, Chao JH.Inhaled Corticosteroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470556/American Academy of Allergy Asthma & Immunology.AAAAI Allergy & asthma medication guide.Ishmael FT.The inflammatory response in the pathogenesis of asthma.J Am Osteopath Assoc. 2011;111(11 Suppl 7):S11-S17.Cazzola M, Page CP, Rogliani P, Matera MG.β2-agonist therapy in lung disease.Am J Respir Crit Care Med. 2013;187(7):690-696. doi:10.1164/rccm.201209-1739PPGosens R, Gross N.The mode of action of anticholinergics in asthma.Eur Respir J.2018;52(4) doi:10.1183/13993003.01247-2017Ye Q, He XO, D’Urzo A.A review on the safety and efficacy of inhaled corticosteroids in the management of asthma.Pulm Ther(2017) 3:1. doi:10.1007/s41030-017-0043-5Cloutier MM, Baptist AP, Blake KV, et al.2020 focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group.Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003Smy L, Chan AC, Bozzo P, Koren G.Is it safe to use inhaled corticosteroids in pregnancy?.Can Fam Physician. 2014;60(9):809-12, e433-5.National Center for Biotechnology Information, U.S. National Library of Medicine: Drugs and Lactation Database (LactMed).Fluticasone, inhaled.
The American Academy of Allergy, Asthma & Immunology.Corticosteroids definition.
Liang TZ, Chao JH.Inhaled Corticosteroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470556/
American Academy of Allergy Asthma & Immunology.AAAAI Allergy & asthma medication guide.
Ishmael FT.The inflammatory response in the pathogenesis of asthma.J Am Osteopath Assoc. 2011;111(11 Suppl 7):S11-S17.
Cazzola M, Page CP, Rogliani P, Matera MG.β2-agonist therapy in lung disease.Am J Respir Crit Care Med. 2013;187(7):690-696. doi:10.1164/rccm.201209-1739PP
Gosens R, Gross N.The mode of action of anticholinergics in asthma.Eur Respir J.2018;52(4) doi:10.1183/13993003.01247-2017
Ye Q, He XO, D’Urzo A.A review on the safety and efficacy of inhaled corticosteroids in the management of asthma.Pulm Ther(2017) 3:1. doi:10.1007/s41030-017-0043-5
Cloutier MM, Baptist AP, Blake KV, et al.2020 focused updates to the asthma management guidelines: A report from the national asthma education and prevention program coordinating committee expert panel working group.Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003
Smy L, Chan AC, Bozzo P, Koren G.Is it safe to use inhaled corticosteroids in pregnancy?.Can Fam Physician. 2014;60(9):809-12, e433-5.
National Center for Biotechnology Information, U.S. National Library of Medicine: Drugs and Lactation Database (LactMed).Fluticasone, inhaled.
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