Inhaled Corticosteroids in Asthma Management

Asthma is a disorder of the lower airways, characterized by bronchial hyperresponsiveness and airflow limitation, the pathogenesis of which is yet to be fully understood. Regardless of its triggers, asthma's hallmark is a state of inflammation that, when uncontrolled, results in persistence of symptoms. Inhaled corticosteroids are established as the mainstay of asthma therapy. This paper examines what is currently available among this class of drugs, features of the ideal inhaled corticosteroid, the delivery systems, dose-response relationships, adverse effects, combination with long-acting beta agonists, equipotent doses among the different types, and several special scenarios that involve the apparent incomplete or lack of response to treatment with inhaled corticosteroids among certain subgroups of patients, such as smokers and obese individuals, and we will discuss the scientific basis of such resistance and suggest alternative approaches to therapy.