Inhaled Steroids (such as Flovent, Pulmicort, and Qvar): Inhaled steroids can be safely given daily for asthma maintenance control. Because the medication is only going to the lungs (where it is needed) and not to the rest of the body, none of the long-term side effects of oral steroids are experienced. There have been exhaustive studies demonstrating that inhaled steroids given daily are safe and effective, and are considered first line therapy for asthma maintenance. These medications generally take a week or more to reach maximal effectiveness. One should NEVER attempt to use these medications in place of a rescue inhaler for acute symptoms. Because these medications work slowly, we will often start patients on a 3-7 day oral steroid "burst." When the oral steroid is finished, we will often then start an inhaled steroid to safely continue daily anti-inflammatory maintenance therapy.
Seretide combination inhaler (contains the steroid fluticasone and longacting beta agonist salmeterol) to be given through a spacer device. The darker the inhaler, the higher the dose. Left hand has 50 mcg, middle one 125 mcg and right hand 250 mcg of fluticasone per puff, whilst they all contain the same 25 mcg dose of salmeterol.
Seretide combination inhaler (contains the steroid fluticasone and long acting beta agonist salmeterol) can also be given as a dry powder in a device called an accuhaler. It comes with different fluticasone strengths - 100, 250 and 500 mcg per puff, always with salmeterol at the same dose of 50 mcg per puff, but I only use the lowest dose as a dry powder.
Symbicort combination inhaler (contains the steroid budesonide and long acting beta agonist formoterol) can only be given as a dry powder in a device called a turbohaler. It comes in different combinations – 100/6, 200/6, and 400/12; the budesonide dose is 100 or 200, the formoterol dose 6 or 12 per puff. I only use the lower dose as a dry powder.
Higher doses of inhaled beclomethasone (more than 1000 mcg/day) may result in more absorption into the body. This may decrease bone formation and increase bone breakdown (resorption), resulting in weak bones and a risk of fractures . Even higher doses (more than 1500 mcg/day in adults and 400 mcg/day in children) may suppress the adrenal glands and impair their ability to make natural glucocorticoid. Patients with such suppression (which can be identified by testing) need increased amounts of glucocorticoid orally or by the intravenous route during periods of high physical stress since higher amounts of glucocorticoids are needed by the body to fight physical stress.