Inhaled Corticosteroids

Inhaled corticosteroids, also called inhaled steroids and abbreviated ICS, are the standard treatment for asthma.  Most patients with AERD have some degree of asthma. In some patients that is the main problem in their disease, and in most patients it seems that the sinus problems are the worst and the asthma is secondary.  For many patients, as the sinus disease worsens, the asthma worsens.

Many people are reluctant to use any kind of “steroid” due to perceptions about side effects and safety.  For asthma, most of those fears are unfounded.  If you have AERD, inhaled steroids are probably going to be part of your foreseeable future.  This medication is known as a “controller” and as its name implies, is meant to “control” asthma.  That is different than the albuterol kind of medicine that is meant as a “reliever”.   Inhaled steroids are meant to be taken daily no matter how you are feeling.  The decision to start them is usually based on the frequency of asthma symptoms, the results of spirometry (breathing test) and exhaled nitric oxide (another breathing test).  The goal of being on an inhaled steroid should be control and prevention of asthma symptoms, prevention or decrease in the severity of asthma flare ups (exacerbations), and improvement in lung function.

Inhaled steroids do have some side effects, although usually not the side effects that people normally think of with “steroids”.  Inhaled steroids can cause thrush (yeast infection in the throat) and hoarseness.  Both of these can be minimized by rinsing the mouth after using.  Inhaled steroids do have a small effect on bone density and in someone already prone to osteoporosis might be an additional risk factor.  Things like weight gain, mood changes, blood sugar elevation and immune system suppression really aren’t an issue with inhaled steroids because the total dose to the body is extremely low.  For most patients, the benefits of being on an inhaled steroid FAR FAR FAR outweigh the risk.

Some inhaled steroids come in a combination with a long acting albuterol type of medication (known as a beta agonist).  These long acting beta agonists (LABA)s are used to help get more difficult asthma under control   These currently are available in the Advair, Dulera, and Symbicort products.