Inhaled vs Oral Corticosteroid for Asthma: what’s the difference?

Corticosteroids or commonly referred to as steroids, are a type of anti-inflammatory drug. Steroids are drugs that closely resemble cortisol, a hormone is produced by the adrenal glands. Steroids work by decreasing inflammation and reducing the activity of the immune system. They are used hence used in many diseases like rheumatological problems, vasculitis, asthma etc.

Steroids are available in many forms like oral syrups & tablets, creams, eye drops, nebulizers solutions, inhalers etc. Steroids are also used commonly in treatment of children and adults with wheezing and asthma in a nebulized or inhaled form. Inhaled steroids act by preventing certain cells in the lungs and breathing passages from releasing substances that cause asthma symptoms.

Steroids if used for prolonged periods and overdoses can lead to significant side effects. This has led to phobia amongst patients and parents against use of steroids. This article focuses on the differences between oral and inhaled steroids, benefits of inhaled steroids and their usage in children with asthma.

INHALED VS ORAL CORTICOSTEROIDS

Why are corticosteroids given by inhalation?
Inhaled steroids are a modified form of corticosteroid used for treatment of children and adults with asthma. When used in nebulized or inhaled form the dose of the steroid is markedly reduced to micrograms. When used in inhaled form the dose is the least. Inhaled steroids gets retained in the airways with minimal amounts reaching our body. Inhaled steroids have proven to be equally effective compared to oral steroids for treatment of children with asthma. Hence, when used in inhaled form these medicines are very effective and carry no significant side effects in long term. Inhaled steroids can be used with other asthma symptoms such as bronchodilators (medicines that open up narrowed breathing passages).

Why are inhaled corticosteroids used for treatment of asthma?
Inhaled corticosteroids are considered to be the most effective anti-inflammatory treatment for long-term management of persistent asthma. The benefits of inhaled steroids are much more compared to any possible minor side effects. Inhaled steroids reduce the frequency of asthma attacks, reduce emergency room visits and hospitalizations, improve daily symptoms of cough, wheezing & breathlessness, reduce the need for bronchodilators and improve lung functions. Inhaled steroids are recommended by all guidelines and regulatory bodies as the treatment of choice for treatment of asthma in children and adults.

Which inhaled corticosteroid is best for asthma?
Research has shown that all inhaled steroids are equally effective in treating asthma when used in equal doses. Most commonly used steroids are budesonide and fluticasone.

What are the advantages of using inhaled steroids vs oral steroids in treating the asthmatic?
Inhaled steroids compared to oral corticosteroids have significantly fewer side effects compared to oral steroids. Hence, inhaled steroids are safe and effective for long term treatment of asthma.

What are the disadvantages of inhaled corticosteroids?
Inhaled steroids are very safe in long term if used in low to moderate doses. No significant adverse effects have been noted. Inhaled steroids can cause adverse effects if used in high dose like weight gain, osteoporosis, failure to gain height and suppression of adrenal axis. Hence, inhaled steroids should always be used in proper doses.

Inhaled steroids (used in metered dose inhalers or dry powder inhalers) remains the most effective medicine for treatment of asthma with no significant adverse effects in long term. They should be used daily as an inhaler to keep your asthma under control to achieve the maximum health benefit. In case you or your child is suffering from asthma you need to get in touch with a pediatric pulmonologist for proper diagnosis and management.

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