Pharmacology
Respiratory
Regarding inhaled corticosteroids, which of the following statements is CORRECT:
Answer:
Inhaled corticosteroids can cause oral candidiasis and patients should be advised to rinse their mouth out with water after using the inhaler. Systemic corticosteroids, not increased inhaled corticosteroids should be given during an acute attack of asthma. Inhaled corticosteroids must be used regularly for maximum benefit, not as and when; alleviation of symptoms usually occurs 3 to 7 days after initiation. Systemic adverse effects may occur rarely, particularly if high doses are prescribed for long periods of time or in concomitant use of other corticosteroid preparations.Inhaled Corticosteroids
Pharmacology / Respiratory
Last Updated: 28th March 2019
Corticosteroids reduce airway inflammation and hence oedema and mucus secretion.
Indications
Regular use of inhaled corticosteroids (e.g. beclomethasone) reduces the risk of exacerbation of asthma.
An inhaled corticosteroid is used regularly for prophylaxis of asthma when patients require a beta-2 agonist more than twice a week, or if symptoms disturb sleep at least once a week, or if the patient has suffered an exacerbation in the last 2 years requiring a systemic corticosteroid. Corticosteroid inhalers must be used regularly for maximum benefit; alleviation of symptoms usually occurs 3 to 7 days after initiation.
Current and previous smoking reduces the effectiveness of inhaled corticosteroids and higher doses may be necessary.
Contraindications
There are no contraindications to the use of inhaled corticosteroids.
Inhaled corticosteroids should be used with caution in people with tuberculosis (potential for exacerbation or reactivation) or in untreated systemic fungal, bacterial, parasitic or viral infection.
Side Effects
Local adverse effects of inhaled corticosteroids include:
- Oral candidiasis, sore mouth, dysphonia, hoarseness (patients should be advised to rinse their mouth with water after inhalation)
- Paradoxical bronchospasm (very rare and usually mild)
Systemic adverse effects may occur rarely, particularly if high doses are prescribed for long periods of time or in concomitant use of other corticosteroid preparations.
Systemic effects include:
- Reduced bone mineral density predisposing the person to osteoporosis
- Bruising, cataract, and glaucoma
- Adrenal suppression , adrenal crisis, coma, and death — very rarely, this has been reported in children taking long-term inhaled corticosteroids
- Psychological and behavioural changes (such as psychomotor hyperactivity, sleep disorders, anxiety, depression, and aggression)
- Growth suppression in children – this does not seem to occur with recommended doses of inhaled corticosteroids
Systemic Corticosteroid Therapy in Asthma
Systemic corticosteroid therapy may be necessary during episodes of stress, such as severe infection, or if the asthma is worsening, when higher doses are needed and access of inhaled drug to small airways may be reduced; patients may need a reserve supply of corticosteroid tablets.
An acute attack of asthma should be treated with a short course of an oral corticosteroid (e.g. prednisolone) or intravenous corticosteroid (e.g. hydrocortisone) if oral intake is not possible, starting with a high dose. An oral corticosteroid should normally be taken as a single dose in the morning to reduce the disturbance to circadian cortisol secretion.
Report A Problem
Is there something wrong with this question? Let us know and we’ll fix it as soon as possible.
Loading Form...
- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
