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What are inhaled corticosteroids? — Inhaled corticosteroids are sprays or powders you breathe in using a device called an "inhaler." They are also called "steroid inhalers." They are used to treat breathing problems like asthma and chronic obstructive pulmonary disease (COPD). They work by reducing swelling (called "inflammation") in your lungs.
Inhaled corticosteroids are also called "controller" inhalers or "preventer" inhalers. That's because they help prevent flares of shortness of breath and wheezing. You need to use them every day, even when you feel well.
Other steroid medicines come as pills, shots, nose sprays, or creams. This article is only about inhaled corticosteroids.
What are some common inhaled corticosteroids? — Examples of inhaled corticosteroids include fluticasone (sample brand name: Flovent), beclomethasone (sample brand name: QVAR), budesonide (sample brand name: Pulmicort Flexhaler), and mometasone (sample brand name: Asmanex).
Corticosteroid inhalers are sometimes combined with a medicine called a "long-acting bronchodilator" in the same inhaler. Long-acting bronchodilators help open the airways. Using a combination inhaler makes it easier to take both medicines together. Examples of combination inhalers include fluticasone-salmeterol (sample brand names: Advair Diskus, Advair HFA), budesonide-formoterol (sample brand name: Symbicort), mometasone-formoterol (sample brand name: Dulera), and fluticasone-formoterol (sample brand name: Breo Ellipta).
How do I use a corticosteroid inhaler? — There are 2 different types of corticosteroid inhalers:
●Metered dose inhalers – Most metered dose inhalers spray medicine when you press down on the top of the canister (figure 1). Some metered dose inhalers are meant to be used with a spacer. A spacer is a device that attaches to the inhaler's mouthpiece. When you press down on the canister, the medicine sprays into the spacer and sits there until you breathe it in. Your doctor or nurse will tell you if you should use a spacer with your corticosteroid inhaler.
●Dry powder inhalers – These release medicine when you take a deep breath in from the inhaler. Different dry powder inhalers are available. Each comes with directions on how to use it.
Most people take 1 or 2 puffs from their inhaler in the morning and 1 or 2 puffs in the evening. Inhaled corticosteroids can only work to prevent breathing problems if you use your inhaler every day, even when you are not having trouble breathing.
Each type of inhaler is used in a different way. Your doctor, nurse, or pharmacist will show you how to use the inhaler prescribed for you. There are separate patient education articles in UpToDate that have more information about each type of inhaler. These are listed at the end of this article.
What are the side effects of inhaled corticosteroids? — Inhaled corticosteroids usually have no side effects or only mild side effects when you use them correctly. Common side effects are:
●Thrush – This is a fungal infection that causes soreness and white patches in the mouth. To help prevent thrush, you should gargle and rinse your mouth with water after every time you use your inhaler. If you do get thrush, your doctor can prescribe a medicine to treat it.
●A hoarse voice
●A sore throat or mouth
Some people who need high doses of inhaled corticosteroids for a long time can have other side effects. These can include increased appetite, bruising, infections, thinning or weakening of the bones, and slowed growth in children.
What else should I know about inhaled corticosteroids? — These are some things to keep in mind:
●Inhaled corticosteroids help prevent breathing problem flare ups. Most of them do not work to relieve symptoms quickly. Your doctor will probably prescribe a different kind of inhaler to help quickly relieve breathing problems, such as asthma or COPD "attacks."
An exception is the combination inhaler budesonide-formoterol. It is often used as a daily controller medicine, but is sometimes also used for quick relief of symptoms.
●It's important to keep using your steroid inhaler every day as your prescription says, even if you feel well.
●Gargle and rinse your mouth with water and spit it out or brush your teeth after you use your steroid inhaler.
●If you are not sure how to use your inhaler or spacer correctly, talk to your doctor, nurse, or pharmacist.
●If you are pregnant or want to get pregnant, talk with your doctor. Inhaled corticosteroids are usually considered safe to use during pregnancy and breastfeeding, but it's best to review this with your doctor first.
For more detailed information about your medicines, ask your doctor or nurse for information from Lexicomp available through UpToDate. The Lexicomp handouts explain how to use and store your medicines. They also list possible side effects and warn you if your medicines should not be taken with certain other medicines or foods.
Patient education: Asthma in adults (The Basics)
Patient education: Medicines for asthma (The Basics)
Patient education: Chronic obstructive pulmonary disease (COPD) (The Basics)
Patient education: Medicines for chronic obstructive pulmonary disease (COPD) (The Basics)
Patient education: How to use your metered dose inhaler (adults) (The Basics)
Patient education: How to use your dry powder inhaler (adults) (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Oral steroid medicines (The Basics)
Patient education: Topical corticosteroid medicines (The Basics)
Patient education: Asthma treatment in adolescents and adults (Beyond the Basics)
Patient education: Chronic obstructive pulmonary disease (COPD) treatments (Beyond the Basics)
Patient education: Inhaler techniques in adults (Beyond the Basics)
Patient education: Coping with high drug prices (Beyond the Basics)