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Inhaled corticosteroids (ICS) are the FDA-indicated treatment of choice in preventing asthma exacerbation in patients with persistent asthma. Persistent asthma is classified by symptoms more than two days a week, more than three nighttime awakenings per month, more than twice a week using short-acting beta-2 agonists for symptom control, or any limitation of normal activity due to asthma. Regular use of these medications reduces the frequency of asthma symptoms, bronchial hyper-responsiveness, risk of serious exacerbation, and improves the quality of life. This activity describes the mode of action of inhaled corticosteroids, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, monitoring, and highlights the role of the interprofessional team in the management of these patients. Objectives: Explain the mechanism of action of inhaled corticosteroids. Identify the indications for using inhaled corticosteroid therapy. Review the potential adverse reactions of inhaled corticosteroids. Summarize interprofessional team strategies for improving care coordination and communication to advance inhaled corticosteroid therapy and improve outcomes and minimize adverse events. Access free multiple choice questions on this topic.

Many healthcare professionals prescribe inhaled corticosteroids, including the nurse practitioner, primary care provider, pulmonologist, ENT surgeon, allergist, and emergency department physician. It is essential to know the adverse effects of inhaled corticosteroids. Patients should receive education about the local adverse effects and strategies to reduce their impact. More importantly, inhaled corticosteroid use correlates with a reduction in growth velocity in children with asthma. However, these effects in low doses of inhaled corticosteroids are small, nonprogressive, and potentially reversible.[12] Inadequate control of asthma also is associated with reductions in growth velocity, and early intervention with inhaled corticosteroids significantly improves asthma control. Thus, the benefits of ICS use outweighs the risk. To optimize therapeutic benefit and mitigate adverse events, an interprofessional healthcare team that includes clinicians, mid-level practitioners, nurses, and pharmacists should oversee and manage patients on inhaled corticosteroids. This approach will lead to the best possible outcomes. [Level 5] There is conflicting evidence on the effect of inhaled corticosteroids on bone metabolism and osteoporosis. High doses of ICS correlate with an increased risk of fracture. Adult patients on chronic ICS therapy should have periodic bone density measurements. Routine testing of bone density in children is not needed, but the recommendation is for supplementation with adequate vitamin D and calcium.[12]